Health Insurance Exchanges: What Are You Really Buying Into?

Health Insurance Exchanges: What Are You Really Buying Into?

By Marisa Torrieri

NEW YORK (Learnvest) — Scott Kraft, a 40-year-old marathon enthusiast, spent more than a decade covering health care policy in the Washington, D.C., area as a reporter before transplanting to Portland, Ore., a few months ago with his longtime boyfriend.

But while he knows the insides and outsides of the Affordable Care Act, and appreciates that he can get access to the same insurance as his friends without asthma (a pre-existing condition), he is having a hard time making the commitment to enroll in a plan through his state's health care exchange website (a handful of states launched their own health care exchange websites when HealthCare.gov launched, as part of the ACA).

The problem: He doesn't know what kind of access to doctors and primary care he'll have whether he enrolls in a premium "platinum" plan, a "gold-level" plan, a "silver-level" plan, or a basic "bronze-level" plan.

"The X Factor has been network availability," says Kraft, who is unable to get insurance through his domestic partner's employer because the two are not married. "I'm fairly new to Oregon, so I don't have a network of doctors. I don't have to worry about, 'Will I lose my provider?' But for all the information I can get on the site, I am struggling to find out, 'What if I can't find a plan ... with a good doctor with an open panel?'"

Kraft's anxiety about the actual "coverage" that comes with these plans—how easy it will be to find a doctor, make an appointment to be seen quickly and related needs — is at the heart of the uncertainty surrounding the enrollment in the Affordable Care Act's health insurance exchange plans. So far, about 100,000 consumers have already enrolled.

Still, many of those who have or plan to soon enroll may be in for a shock when they realize that finding a great doctor and getting the care and services they need may not be as easy as picking a plan on a website—or as "affordable."

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