We’re Dropping Our Group Plan – Can We Keep Our Doctors and Clinics?

Whether you’re an employer who’s considering sending your employees to the individual market or an employee going through this transition with your company, one of your questions is probably going to be, “Can people keep their current doctors or clinics?” We get it: When you find a doctor you trust you don’t want to lose him or her.

The simple answer is “it depends.” In the individual market you have many more choices than you do with a traditional group approach, and it’s likely that your doctor will be in network with some of the plans.

As people shop for the plan that’s right for them, based on factors like healthcare habits and budget, here are 3 important things to know when it comes to doctors and clinics:

  1. Search for doctors: you can check to see which doctors are covered by a specific plan and network, using either a Gravie advisor’s help, or a doctor search tool. When you shop through Gravie, you can always click on the “Doctors” button on the plan tile to go to that plan’s doctor search tool (see below).
  2. Understand plan network: just because a doctor is covered by one plan from an insurance company, doesn’t mean that doctor is covered by all plans from that same insurance company. For example, using the screenshot above, you can see that this is a Blue Cross Blue Shield of Minnesota plan called “BlueAccess HSA Gold.” You do a doctor search by clicking on the “Doctor” icon and find that your current doctor is covered by this plan. As you start to search for other plan options, you find a less expensive plan that looks like it will work well for you. However, you notice that this plan is called “BluePrint Gold” (see below). There’s a big and very important difference between these two plans—the network. You do a doctor search on the BluePrint plan and realize that your doctor is not covered by this plan. This is because your doctor is included in the “BlueAccess” network, but not in the “BluePrint” network. It’s very important to pay attention to network, not just the insurance company, when determining if your doctors are covered.
  1. Know what’s covered by all plans: no matter the doctor and no matter the plan chosen, basic services will still be covered. There are services (known as essential health benefits) that all health insurance plans must cover, according to the Affordable Care Act. Some of these essential health benefits are preventive and wellness services, maternity and newborn care, mental health and substance use disorder services, and more.

When you shop through Gravie, we can help you check if your doctors, clinics, and prescriptions will be covered by the plan selected. Our team of advisors works directly with individuals to provide as much (or as little) support as needed when it comes to understanding the plans available and choosing the best plan for your needs. Plus, we’ll be there throughout the year when any question pops up.

Have another question we can answer? Call us at 844.540.8701, fill out our employer form, or tweet us @gogravie.