As with other payer contracts, physicians generally have a choice whether to accept insurance offered through Affordable Care Act (ACA) marketplaces. But with ACA plans, doctors are more reluctant to speak about their decisions.
One family physician in rural Pennsylvania, for example, spoke with U.S. News & World Report on the topic only on the condition of anonymity. For him, the administrative burden and associated costs for marketplace patients outweighed the reimbursement for treating them, he said, which can be 30 percent to 50 percent lower than with employer-provided plans.
Thus, he's agreed to keep caring for existing patients who had to switch to ACA plans, but that's where his participation ends. "We are not soliciting additional patients [on marketplace plans]," he says. "We get calls every day from people who have those plans, but we can't take them."
Most of what we know about doctors' relationships with ACA exchanges is anecdotal, but 79 percent of physicians who participated in a recent Physicians Practice survey said that they do work with the plans. The top difficulties respondents reported with the marketplace plans included the following:
- Collecting payment from payers--34 percent
- Collecting payment from patients--34 percent
- Patients go to the office only once before dropping the plan, so the office loses money--15 percent
- Miscellaneous reasons, including low reimbursement--17 percent
The 90-day grace period in which patients can keep their coverage despite nonpayment of premiums--during which physicians may end up covering the cost of care if patients ultimately lose coverage--has been problematic as well, according to U.S. News.
As one ophthalmologist wrote into a Sermo poll obtained by the publication, "I stopped taking them after getting burned twice (one was a surgery) where the patients had stopped paying their premiums, but the insurer still had them listed as covered. Fool me once, shame on you. Fool me twice, shame on me."