Can I Keep My Doctor Under the Affordable Care Act?

With the open enrollment period for the 2014 Affordable Care Act, or ACA, well on its way to completion, it's only natural to be wondering whether you can keep your physician. Some hope to keep their doctor because they've known him or her for years, and finding a new one would be inconvenient. Other people require very specific treatments from specialists, and changing doctors would be a potentially dangerous burden. There is a reason we all dread having to find a new doctor, especially after having the same one for years. Unfortunately, answering whether you'll be able to keep your doctor is more complicated than you might expect.

What the ACA says
The health-care reform law is supposed to allow you to keep your doctor. In theory it is supposed to increase the number of primary care providers by giving pay bonuses for primary care services, allowing you access to a greater number of doctors than is currently available.

What's actually happening
While some Americans have been able to keep their doctor, the reality is that not everyone is so fortunate. Those who have lost the specific physician(s) they need the most have been featured in recent reports. For some Americans, this is more than a disappointment -- it has shifted the battle from finding affordable health insurance to a life-or-death circumstance.

Even for those able to keep their doctor, it hasn't necessarily been a happy ending. Some are being forced to pay for more expensive, non-marketplace insurance plans because their doctors aren't included in any marketplace plans' networks. Many marketplace plans don't even offer "out of network" coverage, so individuals wishing to see a doctor not on their plan will be in the same boat as someone without an insurance plan.

What you can do
To better understand whether you can keep your doctor, you will need to contact your insurance company. If you plan to stay on a grandfathered plan and you haven't been notified that your coverage will be terminated, you will probably be able to keep your coverage, as well as your doctor. However, it won't hurt to give your insurance company a call to double-check.

If you've already chosen a plan through the marketplace, check online to see if your provider is in the plan's network. Do this sooner rather than later, because once open enrollment ends, you're locked into your health plan. For those of you who have yet to enroll, when you start researching plans, make sure to look through the providers in each plan's network. If you don't have a specific provider in mind, you can still gain some insight by looking at network size. Evaluating this is pretty simple -- a larger network generally means you'll have more options to choose from.

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  • Report this Comment On January 27, 2014, at 11:00 PM, jmgconsultants wrote:

    In most cases because of the guidelines and the size of the pool you wont be able to keep your doctor. More then 6 million people already found that out.Plus because of the interference by big government in the practices of your doctor many are closing up shop.

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