Health insurance deductibles - ouch

[disneysteve]

Tell you what, post your city or zip and let's see how many ACA providers there are in your community. Pretty easy to find out.

There's no list out there of who "accepts ACA" because ACA isn't an insurance company or plan. It's a piece of legislation. In my area, there are 5 insurance companies available on the exchange with each offering multiple plan options. They each have their own provider network. I'm sure there's a lot of overlap but also providers who may accept some of them and not others. As I said, we're with Aetna and the Aetna network is quite extensive in New Jersey so I don't expect us to have any trouble finding care when needed.

[FrostedMoose]

There's no list out there of who "accepts ACA" because ACA isn't an insurance company or plan. It's a piece of legislation. In my area, there are 5 insurance companies available on the exchange with each offering multiple plan options. They each have their own provider network. I'm sure there's a lot of overlap but also providers who may accept some of them and not others. As I said, we're with Aetna and the Aetna network is quite extensive in New Jersey so I don't expect us to have any trouble finding care when needed.

Not sure where in NJ you are, but I took a quick look at neurosurgeons in network for Aetna Whole Health in a 10-mile radius of Newark NJ. There are nine participating in the Aetna Whole Health EPO (ACA plan), and 52 participating in the Aetna Open Choice PPO. So less than 20 percent of Aetna NSs are participating in the ACA plan in Newark. And I'm pretty sure I don't want my back, neck or head worked on by the nine that opted in. You go ahead and let me know how things go.

[disneysteve]

Not sure where in NJ you are, but I took a quick look at neurosurgeons in network for Aetna Whole Health in a 10-mile radius of Newark NJ. There are nine participating in the Aetna Whole Health EPO (ACA plan), and 52 participating in the Aetna Open Choice PPO.

Comparing an EPO to a PPO is apples to oranges. Those are two completely different plans. Of course they have different offerings. I'm sure they carry different costs, too.

That said, I just looked on the member website for Aetna Whole Health. Within a 25-mile radius of Newark, there are 16 neurosurgeons. Within a 25-mile radius of my home in south Jersey, there are at least 35. I really don't care how many there are on other plans. I think I could make a satisfactory choice out of 35 options (or 16 if I was in Newark).

[FrostedMoose]

Comparing an EPO to a PPO is apples to oranges. Those are two completely different plans. Of course they have different offerings. I'm sure they carry different costs, too.

That said, I just looked on the member website for Aetna Whole Health. Within a 25-mile radius of Newark, there are 16 neurosurgeons. Within a 25-mile radius of my home in south Jersey, there are at least 35. I really don't care how many there are on other plans. I think I could make a satisfactory choice out of 35 options (or 16 if I was in Newark).

The ACA plans are mostly EPO now. Which means very limited choices on providers. You said that it's the same panel of Aetna providers. It isn't. Most doctors aren't participating in ACA. If you feel comfortable being worked on by the doctors that opted in, good for you.

You like ACA. Good for you. I think it's garbage. Good for me. Despite me pointing out facts of much higher costs and very limited provider choices as opposed to other plans.

Time to move on, I don't like meaningless dialogue.

[disneysteve]

Point is, most doctors aren't participating in the ACA. If you feel comfortable being worked on by the doctors that opted in, good for you.

Most doctors don't accept Medicaid but earlier you suggested that that may be a better plan than ACA coverage. I can tell you as a family practice doctor that the ACA plan networks are far better than the Medicaid networks around here.

[FrostedMoose]

Most doctors don't accept Medicaid but earlier you suggested that that may be a better plan than ACA coverage. I can tell you as a family practice doctor that the ACA plan networks are far better than the Medicaid networks around here.

Over 70 percent of doctors nationwide accept Medicaid. Medicaid plans are far richer than ACA, but that's a very low bar.

I'm going to start betting you $100 per fact check so that I can make this worth my while. I'll check the bolded for $100. Deal?

[disneysteve]

Over 70 percent of doctors nationwide accept Medicaid. Medicaid plans are far richer than ACA, but that's a very low bar.

I'm going to start betting you $100 per fact check so that I can make this worth my while. I'll check the bolded for $100. Deal?

I am a practicing physician. I see the limited access to care that Medicaid patients here deal with every day. I see no such access issues with ACA plans. In fact, most of the time I don't even know if a patient has an ACA plan. All I know is that they have Aetna or AmeriHealth or United Healthcare. As long as I refer them to someone in those networks, it's not a problem. Whole different story with Medicaid. Very limited provider list and long waits for appointments. Your opinion doesn't change my real life experience. And I fully recognize that the situation in your area may be different than in my area. I'd only ask that you recognize that same fact. I don't expect you to change your mind about the ACA but at least be open to the possibility that your opinion doesn't mesh with other's reality.

[FrostedMoose]

I am a practicing physician. I see the limited access to care that Medicaid patients here deal with every day. I see no such access issues with ACA plans. In fact, most of the time I don't even know if a patient has an ACA plan. All I know is that they have Aetna or AmeriHealth or United Healthcare. As long as I refer them to someone in those networks, it's not a problem. Whole different story with Medicaid. Very limited provider list and long waits for appointments. Your opinion doesn't change my real life experience. And I fully recognize that the situation in your area may be different than in my area. I'd only ask that you recognize that same fact. I don't expect you to change your mind about the ACA but at least be open to the possibility that your opinion doesn't mesh with other's reality.

I don'l expect to change anyone's mind, but you've made some pretty stark misstatements and contradictions here. This is a saving advice forum. Info. ought to be based in fact. If you like ACA, that's awesome. But don't represent that the access to providers is the same as the rest of the insurance world, that it is somehow less expensive, better coverage, or that the provider network is bigger than Medicaid. None of those things are true, and I've pointed all of them out, except for a direct comparison of the richest ACA plan to a Medicaid plan, and a direct comparison of the Aetna Whole Care (ACA) network in your locale compared to the Medicaid network.

I'm happy to do these, but I think you and I both know the outcome.

State your opinion, but be truthful. Your insurance is cheap not because it's cheap, but because you are being subsidized by some schlub, probably me.

[ua_guy]

YES. I live in a city of over 400,000. My granddaugher was pregnant and there was no OB/GYN in ACA in the entire city. The nearest one was in a small town of less than 15,000 about 60 miles away. He was a foreign medical graduate. Had she not miscarried, she would have had to deliver there.

Only about 30 percent of physicians accept ACA. Facilities/health systems don't provide healthcare; doctors do. If Johns Hopkins accepts ACA, but their referring doctors do not, then it that doesn't do me much good.

I buy ACA, so I have a pretty good idea how much it costs and what it covers - if you can find a provider.

Tell you what, post your city or zip and let's see how many ACA providers there are in your community. Pretty easy to find out.

98201 and 92201

All the major healthcare systems in both areas accept ACA plans and they bill for their providers.


So you have not been denied, your granddaughter was, even though pregnancy, labor, delivery, and newborn care coverage are required to be included in ACA plans. That's certainly not true around here - babies and their moms are covered by ACA plans and they receive care at some of the best facilities and best pediatric facilities in the region.

[disneysteve]

babies and their moms are covered by ACA plans and they receive care at some of the best facilities and best pediatric facilities in the region.

Same here. One of the hospitals in my system has been named one of the top maternity hospitals in the US. They deliver over 9,000 babies per year. And of course they accept ACA plans. So does every other hospital around and most doctors, too. There is absolutely no shortage of care available to people insured through the exchange.

As I said earlier, there are 5 insurance companies on the NJ exchange in our area. There certainly might be doctors who don't participate in any of those 5 plans, but we have yet to encounter any and have had no trouble at all getting quality care. Before we switched to the ACA plan, I made sure that all of our existing providers accepted it, but again, it's Aetna Whole Health, which is virtually the same plan we already had through my employer, so of course we already knew they were all in the Aetna Whole Health network. It made for a seamless transition and we didn't need to change any of our providers.

[ua_guy]

Same here. One of the hospitals in my system has been named one of the top maternity hospitals in the US. They deliver over 9,000 babies per year. And of course they accept ACA plans. So does every other hospital around and most doctors, too. There is absolutely no shortage of care available to people insured through the exchange.

As I said earlier, there are 5 insurance companies on the NJ exchange in our area. There certainly might be doctors who don't participate in any of those 5 plans, but we have yet to encounter any and have had no trouble at all getting quality care. Before we switched to the ACA plan, I made sure that all of our existing providers accepted it, but again, it's Aetna Whole Health, which is virtually the same plan we already had through my employer, so of course we already knew they were all in the Aetna Whole Health network. It made for a seamless transition and we didn't need to change any of our providers.

I don't think there's any disagreement around the fact that some providers don't accept ACA. Some providers don't accept Medicaid, some don't even accept Medicare. Everyone I know on an ACA plan, from downright vulnerable and trying to make ends meet, to "does very well and must purchase private health insurance in the marketplace" are all able to find good care.

Which providers welcome NO insurance? And speaking of the law, we all know there are laws which force providers to provide care for people with no ability to pay. Is it fair? No. Is it just? Depends on one's point of view.

And I'm fairly certain someone can buy a non-exchange plan through a broker or agent just like a private employer does for its employees. It's not like ACA plans are the only option, but they are AN option.

[FrostedMoose]

Same here. One of the hospitals in my system has been named one of the top maternity hospitals in the US. They deliver over 9,000 babies per year. And of course they accept ACA plans. So does every other hospital around and most doctors, too. There is absolutely no shortage of care available to people insured through the exchange.

As I said earlier, there are 5 insurance companies on the NJ exchange in our area. There certainly might be doctors who don't participate in any of those 5 plans, but we have yet to encounter any and have had no trouble at all getting quality care. Before we switched to the ACA plan, I made sure that all of our existing providers accepted it, but again, it's Aetna Whole Health, which is virtually the same plan we already had through my employer, so of course we already knew they were all in the Aetna Whole Health network. It made for a seamless transition and we didn't need to change any of our providers.

Most doctors in your area DO NOT accept ACA plans. I just showed you that by the Neurosurgeon list. It's one third or less of NSs in your area. The Aetna Whole Network is NOT the same as the Aetna Network. I'm not sure what part of this you do not understand.

Most hospitals DO accept ACA, because likely one third of their admitting doctors accept ACA.

You're killing me.

[FrostedMoose]

98201 and 92201

All the major healthcare systems in both areas accept ACA plans and they bill for their providers.


So you have not been denied, your granddaughter was, even though pregnancy, labor, delivery, and newborn care coverage are required to be included in ACA plans. That's certainly not true around here - babies and their moms are covered by ACA plans and they receive care at some of the best facilities and best pediatric facilities in the region.

A nearby hospital to deliver wasn't the issue; it's that no OB/GYNs locally accepted ACA. She would have had to deliver in a town of less than 15,000, by a foreign medical graduate. Hospitals and fine facilities don't deliver babies or perform surgeries. They are hotels for sick people.

Lack of facilities isn't the issue for ACA; it's that only about 30 percent of doctors accept it.

[FrostedMoose]

And I'm fairly certain someone can buy a non-exchange plan through a broker or agent just like a private employer does for its employees. It's not like ACA plans are the only option, but they are AN option.

Sure. I can buy a very good policy that is far better than ACA, but since it's not an ACA mandated benefit plan, I would have to pay a yearly penalty.

[FrostedMoose]

I don't think there's any disagreement around the fact that some providers don't accept ACA. Some providers don't accept Medicaid, some don't even accept Medicare.

You've got things backwards with your wording:

SOME providers do not accept Medicaid: About 30 percent nationwide.

A FEW providers do not accept Medicare: About 7 percent nationwide.

MOST providers do not accept ACA: About 70 percent nationwide.