Lack of access to specialists found in some ACA insurance plans

People who buy health insurance through the Affordable Care Act’s federal marketplace may not be getting reasonable access to medical specialists such as endocrinologists, rheumatologists, or psychiatrists, according to a new study from Harvard T.H. Chan School of Public Health.

Looking at 135 health plans in 34 states that were available in 2015 through the federal marketplace, researchers found that nearly 15% didn’t offer in-network doctors for at least one specialty. Another 5%-10% had fewer than five in-network doctors in specialized fields.

The study was published in the October 27, 2015 issue of JAMA.

By law, insurance plans sold through the ACA’s marketplaces—which offer subsidized private health insurance to consumers in states without their own health insurance exchanges—are supposed to provide “reasonable access” to doctors.

“People need to be really mindful of what they’re actually getting with their plans,” said lead author Stephen Dorner, MPH ’16, and a medical student at Vanderbilt University, in an October 27, 2015 Reuters article. Plans with missing specialists force consumers to pay either the whole cost or more than 50% of the bill for out-of-network care. Said Dorner in a Los Angeles Times article, “This translates into huge cost burdens for patients.”

Senior author of the study was Benjamin Sommers, assistant professor of health policy and economics at Harvard Chan School.

Read the Reuters article: Specialized healthcare may be lacking under Obamacare plans

Read the Los Angeles Times article: Obamacare plans could be forcing people to pay extra for specialist care

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