Insurance Shoppers Face Hard Choices on Health Marketplaces

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Insurance shoppers likely will have several choices for individual health coverage this fall. The bad news? There’s no guarantee they will cover certain doctors or prescriptions.

Health insurers have stopped fleeing the Affordable Care Act’s marketplaces and they’ve toned down premium hikes that gouged consumers in recent years. Some are even dropping prices for 2019. But the market will still be far from ideal for many customers when open enrollment starts Thursday.

Much of the insurance left on the marketplaces limits patients to narrow networks of hospitals or doctors and provides no coverage outside those networks.

Plus these plans can still be unaffordable for people who don’t receive help from the ACA’s income-based tax credits, and they often require patients to pay several thousand dollars toward their care before most coverage starts.

“People understand that things are kind of screwed up,” said Chicago-area broker Robert Slayton. “My objective is to give them what reality is, to give them options. Their job is to choose what may work.”

The ACA expanded coverage to millions of Americans when it established state-based marketplaces where people can buy a plan if they don’t get insurance through work or qualify for government programs like Medicaid. But the expansion has been rough.

Several insurers pulled back from these markets after being swamped with higher-than-expected costs. Many that remained jacked up prices or started limiting the hospitals and doctors included in their coverage networks.

Those narrow networks give insurers leverage to negotiate better rates that can lead to lower coverage prices, and the consulting firm McKinsey & Co. has found that the quality of their hospitals is comparable to broader networks.