This blog post was written by Dr. Nathan Moore, a SteadyMD team member and the author The Health Care Handbook: A Clear and Concise Guide to the United States Health Care System. Dr. Moore is a graduate of the MD program at the Washington University School of Medicine in St. Louis, Missouri and is a practicing physician.
Getting health insurance is complicated, expensive and confusing.
The Affordable Care Act, aka Obamacare, was enacted to ensure that all Americans could get quality, affordable insurance, especially through the new health insurance “marketplaces” (think Travelocity for health care) that were established by the law. Wonderful in theory, but a quick glance at any newspaper or TV station these days will confirm that the exchanges haven’t exactly gone as planned – insurance companies are dropping out, leaving consumers with few choices, and prices continue to rise.
Even worse, spending your hard earned money on insurance does not guarantee you’ll actually get the care you need. Almost half of plans available on the marketplace are “narrow networks” – meaning that less than a quarter of doctors will accept the plan. Good quality primary care is the basis of successful health care but narrow networks often preclude it. Here’s a recap of a recent study of marketplace plans in California from the New York Times:
Using a “secret shopper” approach, the study found that only about 30 percent of attempts for appointments with specific primary care doctors were successful. In this approach, an individual pretending to be a patient seeking an appointment called the offices of over 700 primary care doctors listed in marketplace plan directories. In about 15 percent of cases, the doctor did not accept the caller’s plan, despite being listed in its directory. In nearly 20 percent of cases, the directory included the wrong phone number or the number was busy in two calls on consecutive days. Ten percent of doctors called were not accepting new patients. And about 30 percent of doctors called were not primary care physicians, despite being listed as such in the directory.
So – you’re spending a ton of money for a plan that covers less than 25% of doctors, and only 30% of those will actually take new appointments. I may be rusty with my math, but that’s not phenomenal. Keep in mind that if you succeed in seeing a doctor, there’s no guarantee that your plan will allow you to see him or her next year – leading to further reductions in the quality of care.
People are now realizing that this is a bad deal. To work around it, many folks are ponying up even more to purchase a “gold” or “platinum” plan on the marketplace – but those plans usually just move money around (higher premiums, lower deductibles and co-pays) without providing better physician networks or quality of care.
Another option is what I call the “3-C plan”: Concierge + Catastrophic Coverage. Patients purchase inexpensive catastrophic insurance or a cheaper bronze plan to have in the event of significant, unexpected medical illnesses that require hospitalizations. Think of this like car insurance, which you get to cover for serious accidents but not regular oil changes or fender-benders. In addition to catastrophic insurance, they sign up for a concierge medical service – in person or online – that provides high quality primary care with guaranteed availability and continuity of care with a physician that knows you. In most cases the cost of the 3-C plan is less than buying a silver or gold marketplace plan and the service is much better.
One caution, of course, is to keep an emergency fund available to pay the deductible on the catastrophic plan in the case of a serious medical illness.