With Marketplace Health Insurance, Who Will Care for Me?

Jan. 20, 2015

This week’s Texas Medical Association (TMA) “Hey, Doc” educational segment explains health insurance networks and how they influence patients’ ability to pick a doctor to take care of them. Health insurance plans’ “networks” are important to patients who buy insurance, because they dictate which physicians and other health care providers the plan will cover.

“Hey, Doc” answers questions patients have about marketplace health insurance, established by federal health system reform. Read on, for details.

Who will take care of me? What are networks?

Insurance plans in the marketplace must contract with doctors, hospitals, pharmacies, and other providers to make sure patients have access to medical care. These are the “networks” you keep hearing about.

When you sign up for an insurance plan, you’ll be able to pick a doctor or hospital from those networks to take care of you. But keep in mind that not all plans have the same networks, and some of them might have only a few doctors and hospitals to choose from in your area. So you’ll want to do some homework before you buy insurance to make sure you can get the care you are looking for.

How do I pick a doctor? Where can I find this information?

When you shop for insurance at Healthcare.gov, each plan in the marketplace must publish a directory of the doctors and hospitals in its network. Or if you prefer a live person, you can call the marketplace hotline at (800) 318-2596, and a representative should be able to help you with the application process so you can pick a doctor. Some insurance companies have directories of their marketplace plans and networks on their company websites, so you can check there, too. You can also find phone numbers for the insurance companies on their websites.

But remember: Not all plans have the same networks, and it varies by region, so you might want to shop around to make sure you find a doctor or hospital that’s right for you.

See each week’s “Hey, Doc” Q&A and a lot more at texmed.org/Heydoc as well as in TMA’s patient blog at MeAndMyDoctor.com. And TMA produced “Hey, Doc” videos to help people understand how to navigate the marketplace.

TMA’s upcoming “Hey, Doc” content schedule:

Jan. 28: Can I keep my doctor or hospital when I sign up? How do I find out if my doctor is on my insurance plan’s list? What should I do if I thought my doctor was included but really isn’t?

Feb. 4: Why is it important that I pay my insurance premium on time? How do I know what kind of coverage I have and if I can use my insurance?

Feb. 11: What is my marketplace insurance ID card for? When can I receive my insurance subsidies?

TMA is the largest state medical society in the nation, representing more than 48,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.

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Contacts: 

Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320
 
Brent Annear   


 

Marcus Cooper
phone: (512) 370-1382
cell: (512) 650-5336 
 Marcus Cooper    

 

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Check out  MeAndMyDoctor.com for interesting and timely news on health care issues and policy. 

Last Updated On

March 14, 2018