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Confusion Over Health Care Exchanges Lingers for Patients and Physicians

Patients and those seeking health insurance under the Affordable Care Act aren’t the only ones fighting confusion. Physicians also have a lot of new things to deal with. Representatives with the Pennsylvania Medical Society say there are many confusing points, including understanding how people will be enrolled in the insurance exchanges that opened Monday.

“We have gotten very little, if any, information from most of the insurance companies,” said PA Medical Society President C. Richard Schott, “we know, in different regions of Pennsylvania, the number of plans available ranges from 41 up to 119.”

All of those plans will have differences in co-pays, coinsurance, and premiums, according to Schott. It’s also unclear what will happen when people who are used to not having coverage have greater access to health care.

Schott said there is a culture of many of the patients to wait until they are very sick and then end up in the emergency room.

“Addressing the education of these patients and the cultural aspect of the fact that they’re not used to going to the doctor, not used to getting preventative care, not used to having early intervention when there’s a problem, may be something that will not fix overnight and something we’ll have to work with throughout this process,” he said.

Another point of confusion is overall cost. Schott said very few people understand that once they have coverage under the Affordable Care Act, they are not entitled to free care.

“There’s going to be substantial co-insurance charges,” he said, “for example under the Bronze Plan there’s a 40 percent that is going to be required as a co-pay, as coinsurance, so only 60 percent of their costs are going to be covered by the plan.” 

There are upper limits, but Schott said a family of four covered under the Bronze Plan could still accrue up to $12,000 in annual coinsurance charges.

Millions of people visited health exchange websites across the country on day one and many were not able to get through. The Pennsylvania Medical Society said this could be a for a number or reasons including people going to the website to buy a plan only to realize there are more than 100 to choose from in some cases.

“If they’re quickly signing up for one, I would be a little surprised,” said Schott, “I would think that they would want to take that information and digest it and sort through it before they made any decisions. I’m sure there were a lot of people flooding the websites just out of curiosity.”

Going forward, Schott said it’s clear more education of the public, physicians and those working in physicians’ offices will be needed.