One of the many benefits of health reimbursement arrangements like QSEHRA and ICHRA is the flexibility they allow employees to choose the plan and the doctors that work for them. But what if you can’t find your doctor in-network? These tips should help!
Help! How do I find a plan with my doctor for my HRA?
We want employees to take full advantage of the benefits of their HRA. Part of that is finding a plan that is in-network for their trusted doctors.
Keeping doctors in-network will make this change to the reimbursement model of benefits a lot smoother with a lot less stress.
Here are our insider tips to help you!
- Call your doctor – Ask them which individual plans 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 (for example, 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 or chat with us!
- 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. You can pay the full amount for the visit with your tax-free HRA 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. And remember, you'll be using HRA reimbursements to help cover the costs, so you aren't on your own.
- Consider Tele-medicine – Take Command Health has a membership plan called Smart Benefits that employers can offer to their employees where you 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. Read all about how Telemedicine has saved this mom's sanity.
- 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 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.
HRA compliant plan requirements
As you shop for plans to use with your HRA, there are a few requirements you need to keep in mind.
ICHRA: You'll need a Qualified Health Plan for ICHRA, which is a major medical plan that can be purchased on or off the Exchange. It must meet the minimum requirements as outlined in Public Health Services (PHS) Act Section 2711 and Section 2713. These two provisions require no annual or lifetime limits on the dollar amount for coverage of essential health benefits and full coverage of preventative health services to be covered with no shared cost to the insured.
As a quick reference, these types of ICHRA compliant plans include:
- Major medical plans purchased on the exchange (Bronze, Silver, and Gold)
- Medicare (Part A+B, or Part C)
- Catastrophic Plans (limited to those under age 30 or must qualify for hardship exemption)
- Student Health Insurance
QSEHRA: Before you can participate in your employer's QSEHRA, you must provide proof of Minimum Essential Coverage (MEC). This is easy if you have a major medical plan or are covered by your spouse's group plan, but what if you would like to use an alternative plan like a sharing ministry, short-term plan, or an indemnity plan? These types of plans will not meet the MEC requirement on their own. The good news is there are options to purchase MEC for yourself and your family that will allow these plans to work with QSEHRA. MEC plans can also be a nice complement to sharing ministries, short-term plans, and other alternative plans by covering preventive services not typically covered by alternative plans.
Take the stress out of the enrollment process
For many employees that are offered an HRA, it’s the first time they’ve had to shop for a plan on their own. This can be a daunting and confusing experience. But it doesn’t have to be.
And good news for those of you shopping for an HRA plan outside of traditional open enrollment, both ICHRA and QSEHRA qualify you for a special enrollment period, meaning you'll have 60 days to enroll in a plan. This is a life saver!
Wondering about the individual market in your area? There are often more HRA-compatible options than what you can find on Healthcare.gov or your state exchange. Our enrollment software can help each employee optimize for his or her needs and find an HRA-compliant plan.
We are on hand to chat if you have any questions! We would be happy to help.