Will the Affordable Care Act mean changes to your private insurance?

March 12, 2014 in Personalized Healthcare  •  By Bruce Spector

To keep you informed about the impact of Affordable Care Act (ACA), this is the second in a series of articles highlighting the ACA’s potential effect on healthcare planning for you and your family. In this post, we focus on the law’s impact on people who had individual or employer-sponsored health insurance before the passage of the ACA.

The goal of the ACA is to extend health insurance coverage to millions of uninsured Americans. But what will that increase mean for you and your family? Will you still have access to the care you need? Will the ACA cause changes in your private insurance plan?

Will your insurance change?

The ACA mandated the creation of what is known as the public health exchanges or health insurance marketplace. These public exchanges offer health insurance plans for individuals, people who are uninsured, and some small companies. The public exchanges are run by both the federal and state governments, but the insurance is sold by private health insurance companies. It is not a government insurance plan.

People who have an employer-sponsored health insurance plan usually will not choose to purchase their insurance through the public exchanges. They may, however, have the option to buy their insurance through a private exchange. These private exchanges are set up by an insurance broker, health insurance company or consultant. An employer partners with one of these firms and directs employees to a specific private exchange to choose their health insurance.

Some employers may pay a portion of the cost of employees’ insurance premiums. A growing number of employers are choosing to offer what’s called a defined contribution plan. The employer gives employees a set amount of money to purchase insurance on a private health insurance exchange and employees choose their coverage from the options offered on that exchange. This gives you the power to decide how to spend your healthcare dollars, but it could also increase your out-of-pocket costs for both care and insurance premiums depending on the choices you make.

The largest potential change related to the ACA is for people who buy insurance through the individual market. Most individual insurance plans will be sold through the public exchanges. For people who purchase their insurance through the employer-sponsored private exchanges, there will be few initial changes. Delays in the employer mandate will further lessen the impact for those with employer-sponsored insurance for the first few years. Current insurance plans are not required to comply with many of the new regulations. ­­If, however, a company makes any change in the insurance it offers (different insurer, increase or decrease in deductibles or co-payments, change in benefits, etc.) the plan must then comply with ACA regulations, including the “minimum essential benefits” package.

Will you be able to keep your doctor?

For insurance plans sold through public exchanges, evidence suggests that many are trying to control costs by cutting the number of hospitals and doctors in their networks. Blue Shield of California, for example, dropped nearly two-thirds of the physicians in its network. Cedars-Sinai Medical Center, one of Southern California’s most prestigious and expensive hospitals, is only included in two Health Net plans that have narrower networks and fewer doctors. None of the largest insurers include the hospital. In southern Maine, one-third of the hospitals will be excluded from plans offered through the state’s exchange.

Even before the ACA, analysts predicted that the U.S. faces a shortage of at least 100,000 physicians.  If the ACA results in more physicians retiring or restricting their practice, the shortage could worsen. The ACA will also significantly increase demand for medical services. In Massachusetts, for example, the average wait to see a primary care physician has already increased from 33 to 55 days.

Questions to ask yourself and solutions to consider

  • Will my company decide to drop insurance coverage and will I need to shop for health insurance?
  • Will I face changes or a cancellation of my policy?
  • Will I have access to the doctors and hospitals I prefer?
  • Can I get the care I need when I need it?

There are resources that can help you retain access to the care you need and the physicians you prefer. Consider exploring working with a private health advisory service. These organizations offer a range of services, including facilitating access to top physicians and healthcare centers, providing objective information and support when you’re faced with a serious health issue, and helping you to avoid unnecessary treatments.