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The Marketplace is set up for those who don't have insurance. Isn't a small group of physicians better than none?
Posted by GAGMAN
Not everybody going to the exchanges are uninsured or don't have a doctor of choice - especially the ones that have a pre-existing condition and are under treatment, perhaps charity based. Also those that are within the PCIP or a state high risk pool - I know the PCIP will end on 12/31/2013, so these folks have to find an insurer - I am sure that they would like to continue their continuity of care by having their major medical provider within a network choice - this may not be the case.
Formularies are another thing - HHS/CMS did not write the insurer rules to cover a lot of medications. As with Medicare D, the medication has to be on the list or you have to get an exception somehow. As with Medicare D, drugs are listed by classification - within the exchanges some of the insurers will only have a few choices within these classifications - some generic & some brand.
Remember the "out of pocket" has been eliminated for 2014 - so if an exchange insurer has a medical plan and a prescription drug plan within the same policy but each through a different company - they both may require a deductible so the total out of pocket in 2014 maybe higher than the ACA maximum. This is suppose to change in 2015.
Remember these exchange policies have been designed to keep down medical cost and in turn the premiums that people pay or those premium subsidies. The insurers have had to do some real negotiating to get providers to accept the rate (close to what Medicare provides) - some of the providers just said NO - at least not at this point in time. This became especially hard when the insurers had to establish networks in areas that have few providers; they are having to pay more to these providers to get them into their insurance plan - That is why WY has the highest premiums on the exchange -