Interesting View from My Carrier Rep on Exchange

[insurehound]

If you don't mind, which carrier did you speak to? I understand if you'd prefer not to reveal.

I really would rather pass on that. Sorry! I don't want to get myself in trouble.

 

[taterpeeler]

Exchange plans will NOT have extremely limited PPO Networks. Since many millions of new people will be entering the system and many current patients will be switching to Exchange-Purchased health insurance, it wouldn't be wise for a physician to exclude him/herself from the network(s).

Related Article: ObamaCare Likely To Up Health Usage, Not Control Costs - Yahoo! Finance

-ac

Again... As always I disagree with you.... You are so wrong... Have you ever sold mapd plans?

 

[Ann H]

Thanks for sharing that information, Insurehound! Appreciate it.

I think that Exchange business WILL have limited networks. The Exchange is a Smorgasborg designed for gluttony of over-utilization. At certain (moderate) income levels you can get premium subsidies and also cost-sharing subsidies to pay for copays, deductibles and co-insurance. Utilization will be higher inside the exchange due to the free-for-all nature of it. The only way for a carrier to control utilization is to control access, which means the PCP gatekeeper system, pre-certs for everything, and HMO style administration through the new ACO's. The Medicaid market is almost entirely managed-care due to this need to control over-utilization when the premium is free and the copays are low or non-existent.

Outside the exchange, there is still higher utilization due to GI, no pre-ex, and rich benefits, but it's not a free-for-all like inside the exchange. People pay a premium, deductibles, copays, etc., which helps control utilization.

Outside the exchange, I expect to see at least 1 option for an ACO. In those cases, you'll see identical premiums for identical plans inside and outside the exchange. But I expect the market outside the exchange to offer larger networks, and yet not hike the premium for it. The control on utilization should counter-balance the cost of a larger network. That opens up a whole new ebb and flow of consumer decisions, which may surprise us in the months to come.