QUESTION

I was in the hospital when my coverage changed from my old plan to my new, marketplace plan. My provider during that episode of treatment is no longer in my plan’s network and I’m worried I’ll face higher cost-sharing as a result. Is this allowed?

Post enrollment issues | Individual Health Insurance
ANSWER

Yes, you may have to pay more out of pocket for services from providers who are out-of-network. However, depending on the state that you are in, your new health plan may be required or encouraged to allow you to see your provider at in-network cost-sharing rates through your course of treatment. Check with your health plan or state department of insurance to see if this protection applies to you. (45 C.F.R. § 156.230; CMS, 2018 Letter to Issuers in the Federally-facilitated Marketplaces, Dec. 16, 2016).

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