Healthcare is a complex system and it is an expensive system.  The ACA has a schedule of provisions occurring each year and at the same time the cost for the Affordable Care Act is also increasing.

My suggestion is to explore your options.  The marketplace is like a store front.  Anyone can shop there…some have a “coupon” (entitlement) and some do not.  When it comes to your health and the providers that we want access to when we have a serious illness or injury…it eventually becomes a situation where it has to be “all about the money”.  Our finest doctors have high cost and a long number of years of education.  They have years of experience.  In some states there is “no cap” on their malpractice liability driving their malpractice liability insurance premiums. (i.e. you could have a OB/GYN that does not choose to make part of their practice delivery of newborns, rather see patients with other needs and refer to others in the practice for their expecting patients).  When a patient comes to them they are wearing more than one hat – yes they are a doctors first, however, they are also assessing their liability with the acceptance of that new patient.  They must also assess how they are going to be reimbursed for the liability that they are taking.  If your insurance carrier reimburses them at a very low reimbursement, they may refer you to someone that could be accepting patients with your choice of  insurance.  Think of it as a niche in their market – the doctor taking the lower reimbursement will have volume to offset the low reimbursement.  That doctor may see three patients to the first doctor’s one patient.  In essence, like most things, you get what you pay for.

I have heard from well educated people that have spent many hours trying to navigate the system – then make benefit determinations – and then the cost.  But in the end do they know what provider network they have access to? Do they know how they will be covered if they are out of their “home” location on a trip?  Do they know how their college children are covered several states away?  Do they know if any one of their family would leave the country, such as study abroad, vacation, business, etc. would be treated?  Usually that is no.  For the maintenance issues some lesser quality plans will work, but for highly specialized care or care provided out of a given area, they may not have been your best choice.

To find a plan that meets your needs and your budget we recommend an independent agent.  We will help you with your healthcare options, decisions and budget.  We will also make suggestions for some tax-deferred options.  At Sears Insurance our business comes from repeat clients and the direct referrals they send us…because we know our business and we take care of our clients.  Please give us a call for a free consultation.  Know where you’re at.