With ACOs, there’s also greater access to out-of-network providers. Doctors usually refer patients to specialists who are part of their network, but they have to notify patients of their right to see outside doctors at no extra charge.
Insurers argue such plans actually have certain benefits beyond just price. Specialists in a closed-loop system are more likely to have access to patient medical records, for example, so you are theoretically less likely to undergo unnecessary testing.
Does that make closed network plans a good value for the consumer? The answer depends on your medical needs and the quality of that particular network.
Here are some things to consider before signing up with one of these plans:
Is your current doctor part of the network? If not, you might have to find a new one in order to get your visits covered.
Do you travel a lot? Some HMO-type plans are limited to a relatively tight geographic area, making it difficult to get coverage when you need care in a different part of the country.
What’s the plan’s rating? The National Committee for Quality Assurance (NCQA) grades different networks based on their level of access to care, provider qualifications and health outcomes. The rankings for more than 1,000 health plans nationwide are available on the NCQA website.
With so many changes in the healthcare industry, differentiating among different plans can be a tricky endeavor. If you’re buying a plan on a health insurance exchange, professional navigators can be a valuable resource. And it doesn’t cost you anything to talk with them about your options.
The Bottom Line
HMOs and other closed networks are making a comeback. Before dismissing such plans out of hand, keep in mind that modern HMOs have overcome some of the limitations that plagued older versions – like requiring a referral before you can see a specialist. If you are in the market for health insurance, consider your needs as you check out insurers’ offerings.
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