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Affordable Care Act

What should I do if my doctor is no longer in my healthcare insurance network?

By Asset Protection Planning, Elder Law, Health, Medicaid Planning, Medicare

It is a common problem, but nonetheless an incredibly stressful one: the doctor with whom you have established a good relationship over many years is no longer included in your health insurance network. Whether this is because the doctor has retired, has moved, or is dissatisfied with your network and has chosen to switch, your question is the same: What can I do?

The first thing to do is to check whether you have continuity of care protection. This coverage entitles you to continue receiving the same services from your doctor at the same price, with the same copays and fees. If you are a senior and you have the Medicare Advantage plan, you also have the right to switch networks, given that the network change is “considered significant based on the [effect] or potential to affect current plan enrollees” (Centers for Medicare and Medicaid Services).

If these options are unavailable to you, it is recommended that you talk to your doctor about any alternate payment plans he/she might provide. Or, you can ask for referrals to another doctor in your area.

For expertise in Medicaid planning, Medicare, and elder law, please feel free to reach out to the attorneys at Bach, Jacobs & Byrne, P.A. at (941) 906-1231.

Risk Adjustment Payments Suspended

By Medicaid Planning, Medicare

Risk adjustment payments to insurance companies had been funded by the federal government as part of the Affordable Care Act since 2014 as part of the ACA’s prohibition against insurance companies discriminating against individuals with chronic illnesses or pre-existing conditions. However, the federal government in early 2018 suspended the risk adjustment payment program, citing a recent Federal District Court opinion regarding the formula used to determine the size of the payments.

Some have expressed fears that insurance premiums could increase as a result of the suspension, while others argue that the risk adjustment payment program has already done more harm than good, through a bias against small insurance companies. The Centers for Medicare and Medicaid Services have asked the Federal District Court to reconsider its decision, and, in the meantime, the insurance market hangs tensely in the balance.