Rate Shock vs. Access Shock

Yesterday, we wrote about the net decrease that’s expected in individual health insurance premiums next year. Part of the reason for the lower-than-expected rates, according to the Washington Examiner, is that “the new health insurance exchanges drove a hard bargain with medical providers, and thus many of those providers chose not to participate.”

The result of avoiding the “Rate Shock” that others have experienced has been something the Examiner calls “Access Shock”. Many people sacrificed provider choice for premiums, but now they’re upset that their doctors are not in the network. And, because this is America, there have been lawsuits – plenty of them, especially in California.

Lawmakers, hoping to avoid the “backlash against narrow network plans,” are now proposing new regulations that would increase the number of doctors, especially doctors who “offer medical care predominantly to low-income individuals.” The new rules require plans to include at least 30 percent of these “essential community providers” in their networks, up from 20 percent last year. However, the administration knows that getting too aggressive on the provider issue will increase premiums, which could hurt the party at election time, so this move is seen as “mostly symbolic.”

For brokers, what this means is that these narrow network plans will continue to operate this next year and will provide consumers with a low-cost option. There will also be plans with more comprehensive networks available. Brokers, of course, will need to advise their clients on the tradeoff between access and price. Another possibility is for brokers to do the prospecting and let someone else do the selling. Learn how.

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