Possibly yes, but it depends on the specific plan you choose. Keeping your family's doctors is one of the most important things to check before you enroll, and it's one of the main reasons working with a licensed agent is worth your time.
Every ACA plan has a provider network, which is the list of doctors, hospitals, and specialists that accept that plan. If your doctor is "in-network," your visits are covered at the plan's standard rates. If they're "out-of-network," you may pay significantly more, or the plan may not cover those visits at all (depending on the plan type).
How much flexibility you have depends on your plan type:
- HMO (Health Maintenance Organization): Generally the most affordable, but requires you to use in-network providers and typically requires referrals to see specialists. Out-of-network care is usually not covered except in emergencies.
- PPO (Preferred Provider Organization): More flexibility to see any doctor, including out-of-network providers, usually at a higher cost. Good for families with specialists they want to keep seeing.
- EPO (Exclusive Provider Organization): Similar to an HMO in that out-of-network care isn't covered, but you usually don't need referrals.
- POS (Point of Service): A hybrid. You need a primary care doctor and referrals, but you can go out of network for a higher cost share.
Before you enroll in any plan, use the plan's online directory or call the carrier to confirm that your family's specific doctors, your children's pediatrician, and any specialists you see regularly are listed as in-network participants. Provider directories can sometimes be out of date, so it's worth verifying directly with the provider's office too.
We check network participation for our clients as part of every enrollment. Call us at (305) 330-1277 or Find a plan that fits your family and we'll confirm your doctors are covered before you commit to a plan.
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