Shoppers may again face hard marketplaces choices

Insurance shoppers likely will have several choices for individual health coverage this fall. The bad news? There’s no guarantee they will cover certain doctors or prescriptions.

Health insurers have stopped fleeing the Affordable Care Act’s marketplaces and they’ve toned down premium hikes that gouged consumers in recent years. Some are even dropping prices for 2019. But the market will still be far from ideal for many customers when open enrollment starts Thursday.

Much of the insurance left on the marketplaces limits patients to narrow networks of hospitals or doctors and provides no coverage outside those networks.

Plus these plans can still be unaffordable for people who don’t receive help from the ACA’s incomebased tax credits, and they often require patients to pay several thousand dollars toward their care before most coverage starts.

“People understand that things are kind of screwed up,” said Chicagoarea broker Robert Slayton. “My objective is to give them what reality is, to give them options. Their job is to choose what may work.”

The ACA expanded coverage to millions of Americans when it established statebased marketplaces where people can buy a plan if they don’t get insurance through work or qualify for government programs such as Medicaid.

However, several insurers pulled back from these markets after being swamped with higherthanexpected costs.

Many that remained increased prices or started limiting the hospitals and doctors included in their coverage networks.

Those narrow networks give insurers leverage to negotiate better rates that can lead to lower coverage prices, and the consulting firm McKinsey & Co. has found that the quality of their hospitals is comparable to broader networks.

Plans with narrow networks will cover necessary specialists such as cardiologists, but they often exclude outofstate care providers or academic medical centers, which tend to be more expensive.

They can pose problems for patients who have more than one physician or want to keep a doctor covered under a previous plan.

Plans with some form of a limited network made up more than half of the choices offered for 2017 on the ACA’s marketplaces, according to McKinsey.