Nearly one in three Americans have little familiarity with Obamacare, and the ramifications are playing out in the media. Since each day brings headlines highlighting Americans who are surprised by changes in their health care situation because of President Obama’s signature achievement, The Heritage Foundation compiled three Obamacare items that might surprise you:
1. Your doctor could be outside the network of your Obamacare exchange plan. This could be true even if the insurer said that physician is in its health care provider network. The California state exchange, called Covered California, has had a systemic problem with this issue. Earlier this month, the exchange pulled its physician directory for the second time because of all the errors.
Since the health plans took effect January 1, many Obamacare enrollees in California have complained that doctors won’t take their insurance, despite being listed as part of the plan’s network. Insurance expert Edmund Haislmaier, senior research fellow in Heritage’s Center for Health Policy Studies, says it’s a combination of insurers rushing to get information to the exchanges and the exchanges not updating their directories quickly enough.
Some health care providers could be negotiating with insurers over payment rates, which delays doctors from being in plan networks, Haislmaier added. “This will sort itself out over time but it’s an issue that is still playing out,” he said, advising enrollees to call their physicians first to verify participation in plans offered by the Obamacare exchanges.
2. You might get a better deal if you buy insurance outside an Obamacare exchange. Unless you live in the District of Columbia or Vermont, you can buy health insurance outside the exchanges, either through an insurance agent or directly from an insurer. The biggest disadvantage is that such health plans aren’t eligible for Obamacare’s subsidies.
But some Americans don’t qualify for Obamacare subsidies anyway, such as those making more than 400 percent of the federal poverty level (about $45,960 for an individual or $94,200 for a family of four). For them, buying an “outside” plan could be slightly cheaper.
That’s because in the 36 states where the federal government runs the Obamacare exchange, the Health and Human Services Department imposed a 3.5 percent user fee on the premiums to pay for running Obamacare’s website, HealthCare.gov.
Haislmaier looked at a sample of plans sold both on and off the Obamacare exchanges in those states, comparing the premiums with non-exchange premiums offered through the private, web-based health broker eHealth.com.
He found that for the same plan with the same enrollee characteristics (location, age, and family status), premiums were roughly 2 percent to 3 percent less when buying outside the exchange. “For people who already know that they will not qualify for subsidies, it makes sense to just bypass the Obamacare exchanges altogether,” Haislmaier said.
3. You can’t buy subsidized insurance plans from the Obamacare exchanges after March 31. Lots of news stories have focused on the tax penalty hitting uninsured Americans after that deadline, of course.
But unless you qualify for a special enrollment period triggered by a major life event—a death, marriage, divorce, adoption or birth of a child, an out-of-state move—you’ll have to wait until open enrollment starts October 15.
Depending on the state laws, consumers may be able to buy coverage outside the exchange, but those non-exchange plans won’t be eligible for the government subsidies.
This story was produced by The Foundry’s news team. Nothing here should be construed as necessarily reflecting the views of The Heritage Foundation.