Consumers learn that in some cases there is no maximum on out-of-pocket costs if they see out-of-network providers. (Getty Images)
Editor’s note: This post is part of the ongoing Ask Emily column, a project of the nonprofit CHCF Center for Health Reporting. Reporter Emily Bazar answers consumer questions about Obamacare. In this issue, Bazar takes a look at the potential costs of visiting an out-of-network doctor or other provider. This is an issue anyone with health insurance should pay attention to.
Q: I learned today that the health “insurance” I purchased for my family through Covered California does not have ANY maximum out-of-pocket cost on out-of-network providers. … How is that even possible? Our family is now faced with potentially infinite costs that could wipe us out.
A: Let’s start with a quick refresher.
Consumer learns there is no maximum on what she must pay for out-of-network doctors she saw.
An out-of-pocket maximum is the most you would pay during the term of your health policy (usually one year) before your insurance begins paying 100 percent of covered medical services.
Deductibles, co-pays and other costs generally count toward your out-of-pocket maximum. Your monthly premiums don’t. Continue reading
By Dan Diamond, California Healthline
Search Covered California’s website, and you’ll find a list of 33 “frequently asked questions.”
The 33rd and final question — below questions like “Why should I buy health insurance?” and “I’m pregnant and do not have insurance. What health coverage is available for me?” — is this one: “Will patients be able to keep their same doctor when they purchase health insurance through Covered California?”
The question may be last on Covered California’s list, but it’s top-of-mind for many consumers. About one million Californians, and millions of other Americans, are losing their health plans through the individual market and turning to Obamacare’s new insurance exchanges to shop for replacement coverage. And in many cases, it’s still unclear if the family doctor will be coming with them.
The Mechanics Behind Narrow Networks Continue reading
Darren Hall will have to choose a new health insurance plan after Obamacare is fully implemented in January. His policy today doesn’t meet the standards outlined in the law. (Kelley Weiss/ CHCF Center for Health Reporting)
By Kelley Weiss, CHCF Center for Health Reporting
Despite promises by President Obama that people can keep the insurance they have once Obamacare is in full effect in January, millions of people nationally will have to upgrade their policies.
That’s because these people have “bare bones” plans that don’t meet the Affordable Care Act benefit standards.
Darren Hall is one of those people. He runs a pool service company in Sacramento. Since he’s self-employed he doesn’t get health insurance through his job, but buys it on his own.
He says it’s worked out pretty well until this spring when his monthly premium spiked from $250 a month to $300 dollars overnight.
So he says he looked for a better deal and found another health insurance policy for half as much.
“As a small business you have your ups and downs and so every dollar does count,” Hall says. “Another $150, that’s half a truck payment right there.” Continue reading
By Mina Kim, KQED
California’s insurance commissioner Dave Jones says Anthem Blue Cross shouldn’t be allowed to sell small business health plans on Covered California, the state’s new health insurance marketplace being set up under the requirements of the federal health law. Jones says Anthem, the state’s largest insurer, has been engaging in a “pattern” of “excessive” rate hikes.
“It simply cannot be the case that a health insurer can unreasonably gouge its small business customers and not face any consequences whatsoever,” Jones said.
Under state law, Jones can review health plan rate hikes and declare them unreasonable, but he lacks authority to block them. Continue reading