Can I Keep My Doctor with This Health Insurance?

Jan. 28, 2015

It’s probably one of the most common questions for anyone shopping health insurance: Can I keep my doctor on this plan?

The Texas Medical Association’s (TMA’s) “Hey, Doc” educational campaign about the health insurance marketplace (created by federal health system reform, or the Affordable Care Act) answers that question this week, and more.

Can I keep my doctor or hospital when I sign up?

Maybe. Not all doctors and hospitals are participating in the marketplace. And not all marketplace plans have the same doctors and hospitals. So keeping your doctor or local hospital depends mostly on the insurance plan you choose. Before you buy, it’s a good idea to check not just the costs of the plans, but also whether your doctor and hospital are in the plan’s network if you want to keep them.

 If your doctor and hospital are in your plan’s network, then chances are you can still get your care from them. If your doctor or hospital is not participating in your plan network, then you’ll probably have to pay more out of pocket to continue seeing that doctor or getting care at that hospital. That’s because most marketplace insurance plans require you to use the doctors and hospitals in their networks. So you’ll have to decide what’s affordable for you.

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?

If you’re not sure if your doctor participates in your insurance plan, there are few ways to find out.

Remember that marketplace rules require plans to publish an online directory of participating doctors on Healthcare.gov. It’s important to check those lists before you buy insurance to find out if your doctor is in the plan you want. You also can call your insurance company to check if your doctor is in the plan. Or, the information might be included in the welcome packet you got when you first enrolled. 

You might have heard about some confusion over whether the insurance plan lists online are up to date. If you aren’t sure, call your doctor directly to find out if he or she is participating in the plan you choose.

If your current doctor is not in your plan, you have a few options: 

•     If you decide to keep your doctor and he or she is not in your plan, you may have to pay the full cost of your medical bills.

•     You can choose another doctor within your plan.

•     You might be able to switch to a plan that does include your doctor during open enrollment.

And if you do decide to switch, be sure to ask your doctor first which plans, if any, he or she takes.

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 “Hey, Doc” upcoming content schedule:

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?

Feb. 18: What will it cost me to use this insurance? What are deductibles, coinsurance, and copayments? What are the limits on out-of-pocket costs?

Feb. 25: The specialist I need is not on my insurance plan’s list of doctors. What do I do if I’m having problems with my marketplace plan?

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  

Click here to follow TMA on Twitter. Or visit TMA on Facebook. 

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

Last Updated On

March 14, 2018