Can't find a health plan with your doctor?
You're not alone. Many of our clients are having trouble finding health plans with their doctors this year. The reality is doctor networks are shrinking and fewer health insurance companies are offering plans to individuals. Individual plans typically reimburse doctors less for services than large group or employer plans. As a result, many doctors with established client-bases are no longer accepting even the individual plans that remain.
Before you give up, make sure you've tried our doctor search tool. It's the most comprehensive search we know of and will help you quickly search all play types in your area--Healthcare.gov plans, private plans, and even faith-based options.
As a reminder, all health plans cover emergencies anywhere in the US. Just make sure it's a real emergency or you'll get a huge bill. Also, not every plan covers emergencies if you're traveling outside of the US. Email us at firstname.lastname@example.org if you're traveling overseas.
Try these tips to keep your doctors
If you've already tried that and you're stuck, here are some tips on what you can do next:
- Call your doctor – Ask them which individual plans (if any) they will be accepting next year. Often you’ll get discouraging responses from receptionists like “we don’t take any marketplace plans” but often they are wrong. Instead, ask them about the particular network names (IE, Aetna's "Open Access EPO" network). If they accept that network, then they have to accept your plan no matter where you purchased it. If you need help identifying the proper network name for a health plan, email us at email@example.com or chat with us at TakeCommandHealth.com.
Note: We do our best to keep our doctor search up to date. However, we err on the side of telling you your doctor is not in network if we can’t find a close enough match (the data we have to search through is a mess). Please let us know if you call and find out they are in network so we can update our records accordingly.
Finally, when you're on the phone, don’t be afraid to be a consumer. Doctor's need patients to make money! My wife’s OBGYN was going to drop the plan we were on last year, but we convinced them they’d lose a significant number of clients (including us) that they decided to keep it. You never know if you don’t ask.
- Split plans - Often families can find their doctors, but they are spread across several plans or the one plan that has them all is too expensive. It used to be risky to split plans, but that's no longer the case and the extra financial exposure is very minimal. In reality, the biggest hassle is keeping up with multiple ID cards. We have several family clients who have put the kids on their own plan and then each adult on their own.
- Pay Cash – If you only see this doctor once or twice a year for regular check-ups, consider paying cash for those visits. A typical office visit is $150-$250. Usually doctors charge lower cash rates than if you bill through insurance anyway. If you choose a plan with an HSA (Health Savings Account), you can pay for the visit with tax-free dollars. We don’t recommend this strategy if you need routine care from a doctor.
- Look for plans with out-of-network benefits - Plans with PPO doctor networks will pay for out-of-network coverage but at a much reduced rate. You may also have to hit a higher deductible amount before benefits kick in (read: greater than $10,000). If you're facing a situation where you need large amounts of care from a particular doctor or hospital system that you can't find to be in-network on any plans, this is better than nothing. You'll have to satisfy the higher deductibles and max-out-of-pocket amounts, but it's still better than trying to absorb the full-cost of care on your own.
In addition, some POS and "HMO+" networks will offer out-of-network benefits. The most common are the Blue Cross multi-state plans. Check with us for more details before you go this route.
- Consider Tele-medicine – Take Command Health members who subscribe to our membership plan can call a doctor 24/7 for $0. Not a bad deal and can help reduce sick-visit costs significantly. In this case, there's no worrying about "in" or "out" of network.
- Set-up a small business to get a group plan – Several of the larger PPO networks are still available for small groups. However, there are some stringent requirements though for small groups now: you typically have to have at least one W2 employee that is not a family member or relative. You’ll also be subject to minimum participation rates (except for a brief open enrollment window) and everyone will have to be on the same plan. It can be done but is tricky and there’s no guarantee your group will be accepted. One good thing though about group plans is you can start them anytime and they are not subject to enrollment periods like individual plans. If you want to try for a group, we recommend you sign up for an individual plan now through TakeCommandHealth.com and then email us at firstname.lastname@example.org and we can help you look at your group options after Open Enrollment. If your group is accepted, it can start immediately and we’ll cancel your individual plan.
- Find a new doctor (for now) – Well, this was probably the tip you didn’t want to hear, but sometimes it’s just too expensive to keep a doctor if you’ve already tried all of the above. We know this is not anyone’s preference, but we can help ease the transition. Our doctor scheduling feature (coming soon) will help you find primary care doctors and specialists in your area. You can read reviews, view locations on a map, and even book online. There’s always a chance your doctor will land on a network you can purchase again (they change every year) and hopefully new healthcare reforms will improve insurance options for individuals.
Hope that helps! If you think of other tips or tricks, please contact us so we can update our list.
Even if we can't find a plan with your doctor, we'd still love to help you find a health plan that will meet any other needs you have for prescriptions, conditions, etc. To start our guide and see the options available in your area, please click the button below.
I wrote this blog to help people make smart health insurance decisions. I am a small business owner, a husband, and a dad to three boys, so I've seen firsthand how important understanding insurance decisions can be. As a co-founder of Take Command Health and a licensed health professional, I've been recognized as a leading expert on healthcare transparency and defined contribution arrangements (QSEHRA). I've been featured in the New York Times, Wall Street Journal, Dallas Morning News, Forbes and others. Learn more about me and connect with me on our about us page. Thanks!