Some Doctors Are Wary of ACA Exchange Patients


People who have obtained health insurance through the Affordable Care Act exchanges are struggling to find physicians who will accept them as patients.

Medicaid rates are lower than those of Medicare, which are usually lower than commercial insurance plans. ACA policyholder rates can be up to 50% lower than commercial rates. Dr. Andrew Kleinman, president of the Medical Society of the State of New York, stated, “Physicians who are in solo practices have to be careful to not take too many patients reimbursed at lower rates or they’re not going to be in business for very long.”

It is important for consumers to research physician and hospital networks for accepted plans before they purchase. Jon Founer sued Empire Blue Cross because he called at least 30 doctors, and none of them would accept his ACA exchange plan. Insurers want to work with smaller networks of doctors and hospitals to help reduce costs, but this limits the number of doctors from which a patient can seek care.

On the other hand, physicians want it to be clear on insurance cards that a patient has an exchange plan, so they can know whether to accept the plan or not. Currently, doctors in Texas are trying to get the state to require insurance cards to make exchange plans clearly stated.

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