As time goes on, some flaws in the Affordable Care Act have become more and more apparent. The Department of Health and Human Services has finalized three changes that will occur next year in the 38 states who use the federal exchange to purchase health insurance. These Obamacare changes coming next year are intended to alleviate some common problems people seem to have when selecting and even using their health insurance plans.

Size of Insurance Networks

The first change relates to the sizes of insurance networks. When a health care provider is removed from an insurance network, the insurance company will be required to provide consumers with a 30-days’ notice prior to the removal. Additionally, should a patient be in active treatment for a condition (chemotherapy, for example), the insurance company must continue to provide coverage for that provider up to 90 days. This new rule should give consumers a heads-up so that they have plenty of time to find a new provider before their old provider is removed from the network.

Another small change pertaining to the size of insurance networks is in the works. Next year, consumers will have the ability to see just how big (or small) a network is. Though not necessarily in this wording (but the same idea), a plan’s network will be classified as either basic, standard, or broad… or in plain English, small, medium, or large. Someone with a lot of medical concerns may feel more comfortable with a larger network with more options to get their care. Someone with few to no medical concerns may be okay with a smaller network because they don’t believe they’re likely to use it frequently.

More Standardized Plans

The next change is only a possibility at this point. Federal regulators are requesting that insurers willingly offer plans with a standard set of costs from deductibles to office visits to prescriptions. Because many plans require people to meet their deductible before something such as an office visit to a primary care provider or trip to an urgent care is covered, these plans would offer a flat rate for such services within that category (bronze, silver, etc.). Ideally, this will make shopping for and comparing plans more easy for the consumer.

Again, this change is only a possibility at this point. Because federal regulators are only requesting this of insurance carriers, there is no requirement for them to comply with what the regulators are asking.

Surprise Medical Bills

The third and final change deals with those surprise medical bills that nearly everyone seems to receive at some point following medical care. These often happen because even though a healthcare provider is in-network, ancillary care associated with the visit may not be. Ancillary care are services that are provided to a patient that support the work done by a primary physician. Lab work, radiology, and anesthesia are some common examples of ancillary care.

The new rule will require that payments for out-of-network ancillary care go toward a person’s out-of-pocket maximum. This is helpful because the more that can be applied to the out-of-pocket maximum the better, because once the out-of-pocket maximum is met, the insurer is responsible for paying for all in-network care from there on out for the rest of the year. However, if the insurer has warned patients within 48 hours prior to a medical procedure or hospitalization, this rule does not apply. The logic here is that if consumers are warned beforehand, they still have time to perhaps find an in-network provider for their ancillary care.

Before any planned medical procedure, be sure to keep an eye out for any communication from your health insurance carrier warning you of these out-of-network expenses.

Keep these changes in mind next year. Doing so could save you money and lead to better selections of health insurance plans.

Citations

  1. Appleby, J. (2016, March 15). Three changes consumers can expect in next year’s Obamacare
    coverage. Retrieved from Kaiser Health News website: