QUESTION

My doctor’s office is located in a neighboring state. Will I still be able to see him if I get a plan on the marketplace?

Individuals with no coverage | Navigating Health Insurance Marketplace Options |
ANSWER

It will depend on whether or not the health plan you choose covers your doctor. Some plans may offer a broader scope of covered providers than others. To make sure your doctor is covered under a plan, you should call your provider and ask. Note that it is important to ask the provider not just about the insurance company offering the plan, but whether they participate in the network of the specific Marketplace plan the insurance company is offering. However, before selecting a new plan, you should also confirm with the plan directly that your doctor is in-network. While every plan on the Marketplace must provide a link to its health provider directory, these lists are often not accurate or up-to-date. While you can incur significantly higher out-of-pocket costs if you obtain services outside your plan’s network, you should not be obligated to pay more than your in-network cost-sharing if you were seeking care from a provider you believed to be in-network due to an inaccurate provider directory. (45 C.F.R. § 156.230; CMS, The No Surprises Act’s Continuity of Care, Provider Directory, and Public Disclosure Requirements.)

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