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.
I keep my doctor or hospital when I sign up?
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.
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?
you’re not sure if your doctor participates in your insurance plan, there are
few ways to find out.
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.
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.
your current doctor is not in your plan, you have a few options:
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.
can choose another doctor within your plan.
might be able to switch to a plan that does include your doctor during open
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
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.
phone: (512) 370-1381
cell: (512) 656-7320
phone: (512) 370-1382
cell: (512) 650-5336
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.