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Limitations on Plans in the Affordable Care Act

As a quick follow up to my post last Friday regarding the Affordable Care Act being less affordable for the middle class, I want to mention a timely article in the New York Times published today.


In summary, the article suggests that when less expensive/more affordable health care plans are available in the soon-to-be-implemented health care exchanges, they will actually be very limited in the number of doctors offered in the plan. For example, in more expensive plans, the number of in-network doctors are very plentiful. In contrast, in less expensive/more affordable plans, the number of in-network providers will be greatly limited to hold down costs.


But I’m not sure what is the cause or effect on cost here. Are the plans less expensive because they’re paying in-network providers and hospitals less and so the patient is on the hook for more out-of-pocket expenses? Or is cost less because the administrative costs are reduced with few in-network providers and hospitals to bother with? This may bring about a resurgence in HMO’s circa 1980’s since they severely limit your choices in providers.


Regardless, I thought this article shed new light and a new angle on this upcoming seismic shift in healthcare.



2 Responses

  1. I think you should let the program begin and see how it goes. Many current plans limit doctors and many current plans drive doctors out. This is not an ACA issue. It’s a private insurance industry/reimbursement problem.

    1. I don’t disagree with you that we should see how the program plays out. I hope it’s better for everyone. But I do believe that in an effort to keep costs down, there will be more plans with limitations on the number of doctors in-network. I’m not suggesting this problem started with the ACA but I do think it will be a technique exploited by the insurance companies to keep more premiums and pay out fewer benefits! Thanks again for the continuing discussion.

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