Q. My doctor posted a sign saying she ‘doesn’t take Obamacare.’ What should I do?
A. It depends on your relationship with your doctor. If you’re not particularly attached to her, it might be easier to just find someone new. But if you prefer to continue working with her, you’ll need to have a conversation with her or with her office staff to determine what carriers she still has network contracts with.
Obamacare is not an insurance policy or network. It’s just another name for the Affordable Care Act (ACA), which is a law that was enacted in 2010. All new individual and small-group health insurance policies had to be fully compliant with Obamacare starting January 1, 2014. This is the case regardless of whether they’re sold through the exchanges or purchased directly from a carrier (ie, “off-exchange“). The ACA also imposed some new regulations on large group and self-insured plans, but not as extensively as it regulates the individual and small group markets.
Grandfathered health plans are those that were in already in effect on March 23, 2010 (when the ACA was signed into law), and they do not have to become fully ACA-compliant as long as they don’t make significant changes to benefits or cost-sharing (even grandfathered plans do have to comply with some ACA provisions, though).
Transitional, or “grandmothered” health plans are those that were purchased after the ACA was signed into law, but before October 1, 2013 (December 31, 2013 in some states). HHS allowed these plans to extend into late 2014 if states and carriers permitted it, and then later provided additional leeway, ultimately allowing these plans to continue to remain in force (currently through 2022), at the discretion of states and carriers. These policies do not have to be fully ACA-compliant, but they must adhere to more provisions of the law than grandfathered plans.
So there are still some health plans that are not fully compliant with Obamacare. But if a doctor hangs a sign saying that she’s “not taking Obamacare” it probably means one of three things:
- She’s no longer accepting any new health insurance policies (only grandmothered and grandfathered plans, which are shrinking in number every month) that are sold in the individual market.
- She may be conflating “Obamacare” with “exchange plans” even though ALL new individual and small group policies are regulated the same way, regardless of whether they’re purchased through the exchanges. (Provider networks can be different however, which could explain her sign). If that’s the case, she may be concerned about the fact that plans with premium subsidies have a three-month grace period if insureds fall behind on their portion of the premium subsidies. Plans sold without premium subsidies (which includes all plans outside the exchange, and about 15% of plans inside the exchange) have a one-month grace period instead. It’s understandable that the provider could be worried about being stuck with unpaid claims for an insured who is receiving a subsidy and ends up with a lapsed policy. You can ask your doctor if this is part of her concern, and discuss potential solutions with her.
- She’s making a political statement and voicing her opposition to the law.
In many states, health insurance carriers sell the exact same plans on and off-exchange. But in some cases, policies are sold with different provider networks depending on whether the policy is sold through the exchange. It’s possible that your doctor is not included in the networks for exchange plans, and that when she says “Obamacare plans,” she’s referring to plans sold through the exchange.
In some states, the networks are the same on and off-exchange and there would be no way for a doctor’s office to know how the policy was obtained. Of course, there are also many policies that are sold only through the exchanges or only outside the exchanges. For those plans, it’s obvious whether they were purchased on or off-exchange. Exchange plans in Texas must include the designation “QHP” on ID cards, and some states put an “X” on the ID cards for exchange plans. In California, Anthem’s ID cards have the Covered California logo if the plan was purchased through the exchange.
If you want to continue working with your doctor, you can ask her what health insurance carriers she’s contracted with, and select a policy from among the ones she mentions. Situations like this are not as common as they were in 2014, but changes like the ACA often have a steep learning curve, and all of us – including doctors – have to make our way along that curve.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.