In January 2014, the Affordable Care Act (ACA, or Obamacare) will create many changes in everyone's medical care. Some of the changes are good, some very challenging, and some frankly bad.
The most important changes are in insurance policies and in which physicians can accept the new insurance policies (participating physician networks). Also challenging to everyone are the changes in physician attitudes (anger, confusion, burn out) and practice structure. Some physicians are joining hospitals, some are retiring, and many are merging.
Some of the changes from the ACA are very helpful. No longer will insurance companies cancel policies due to claims for services (they used to do this, eliminating the health care lifeline on which so many people with life-threatening illnesses were depending). Also, insurance companies cannot refuse to issue a policy due to pre-existing conditions (this is called guaranteed issue). The annual and lifetime maximums for payments have been eliminated.
And in 2014, preventive care is now covered and paid for. Also, if you are challenged by a serious illness, insurance must cover your care while you are on any clinical trial, providing access to the newest and most promising new therapies.
Here are my suggestions of the steps to take now to help you prepare and protect yourself:
• Be certain you continue to have insurance. Check with your insurance company, employer or union to be certain your current policy will continue, or if it will be cancelled.
• If your insurance will be cancelled, check out the exchange in your state to find out what your options are. Consider using an insurance broker to help you if you are confused by what you see on the exchange. Contact your insurance company to find out what their new policies are, and what their benefits will be and which doctors will participate in their plan.
• Never go without any insurance, even if you have to choose a plan with high deductible and higher cost than before. Why? If you do not have insurance, an accident or a sudden illness (infection, stroke, heart attack, ulcer, appendicitis, kidney stone, etc.) could result in hospital and physician charges over $100,000, and without insurance there is no insurance discount high medical costs which some people cannot afford often lead to bankruptcy.
• Next, once you know which insurance you will continue to have or which plan you are considering purchasing, check with your doctor immediately to see if he/she is going to continue to accept that insurance plan. Networks are changing, and the doctor may be excluded next year. Never use a doctor or hospital or lab or radiology unit that is out of plan, or expenses will just be too high.
• Find out from your doctor if he/she is going to join a different network or hospital, retire, hire new nurse practitioners, or change his/her work location or hours. You need to be prepared if your physician is going to have major changes that will modify your medical care.
• If your doctor will not be covered by your insurance next year, start finding a new doctor now (or find a new insurance which your current doctor will be accepting). Your current doctor or specialists can suggest other physicians, and also let you know if they are good or average or poor.
• Begin to ask now about preventive care including any X-rays or tests you will need to screen for serious illnesses. You might want to get them this year rather than next year when co-pays or deductibles may be higher.
• Get any symptom evaluated and treated this year before costs increase.
• Be aware of changes in your physician's attitudes and demeanor, since it may give you hints that the doctor has become frustrated, depressed, overwhelmed, or just burnt out. Ask the office staff about the doctor to be certain he/she is still fully prepared and enthusiastic about giving you high quality care. If you have specialists as well, you can ask them if your doctor is still excellent and not overly busy or burnt out.
• Questions like, "Is the doctor okay with all these changes going on?" or "How are you all in the office going to cope with the changes next year?" can help you and your family determine if you have to consider finding a second opinion about your health and treatments.
For more advice on getting better care now and knowing what questions to ask your doctor, see my book Surviving American Medicine. It will give you tips on getting the right doctors, insurance and hospitals.
You need to take charge of your medical care now more than ever. If you do this well, you will have confidence in the future. Letting things just happen around you may lead to bad decisions, serious undiagnosed illness, suffering, disability, and sometimes even death.