Why there are new networks since the ACA

Since passage of the Affordable Care Act (ACA), insurance companies have worked diligently to retool and tweak their offerings to accommodate the requirements and demands of the law. Some of these changes have made it more difficult to accurately compare insurance plans and benefits. One area of change health insurance consumers must be aware of is the use of “new networks.”

A provision of the ACA has the effect of limiting insurance companies spending on overhead by requiring the companies to spend at least 80% of premium revenue on “medical care and efforts to improve the quality of care.” When matched with the requirement to provide all 10 Essential Health Benefits[link] in each plan, the insurance companies look for ways to control spending.

One way to do this is by creating new provider networks that limit the doctors and hospitals included as “in-network” providers. Typically, these networks rely on providers that offer the best discounts to that insurance company. The result is a provider network that stands beside the insurer’s traditional network. Another is to make the plan an HMO design[link], to make the less-expensive network required for exclusive use by policyholders.

Given what we have, how should a consumer think about all this in choosing health insurance? Here are some ideas:

  1. If you are a new consumer of health insurance, none of this may matter to you. Pick a doctor from the new network and have coverage if you need an emergency room or generate big medical bills.
  2. If you’re facing the double-whammy of high premiums and low use of the plan (that is, you never get sick), you may be willing to give up any out-of-network doctors in exchange for lower premiums.
  3. If you have significant, ongoing medical costs, specialized doctors/facilities, or travel a lot, you may require the traditional type of health insurance. Happily, there are still PPOs[link] with national networks to serve these needs as well.

What’s right for you? CHB is always available to provide quotes and help with making decisions among the various plans and companies.

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Friends From Long Ago

This past weekend, August 17-19, 2012, I had a reunion with a couple of my closest friends from the time I was in the Peace Corps in Venezuela. I had seen Bob Buffin a few times over the past few years, but this was the first time since 1968 I had met up with Bart Briefstein. Sure, we are 44 years older, but in most ways it didn’t feel as though we had changed very much. We quickly fell into the same character and relationship rolls we had all those many years ago.

Bart’s Peace Corps experience was perhaps more impactful on him than it was on all the rest of us, as he met Marina in Caracas.

Bob’s time in the Peace Corps was important to him as well. After his two year assignment, Bob became a recruiter with the organization for a number of years. Later he earned a law degree from the. They have been married all these years with two grown children. Bart’s business career took the family from NYC to Minneapolis for many years. Later they had stops in Austin, San Miguel de Allende, Mexico and Prescott, Arizona. They presently reside in Reno and take advantage of all that city’s cultural offering to keep active. Bart is still as clever as always.

University of Wisconsin and eventually went to work for the National Labor Relations Board for 35 years. Bob recently retired after 42 years of government service. Bob lives with his long-time partner, Karen, in Half Moon Bay, south of San Francisco. Bob plans to get back into music (he played his guitar on many a long bus ride in training to entertain the rest of the trainees) and keep up with his wine making (we all agreed his Shiraz was excellent).

My service was important to me as well. The association with other volunteers, many of whom were quite high quality individuals, gave me the confidence and desire to do much more with my life than I had heretofore considered.

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