What Physicians Should Expect as Newly Insured Seek Care

Some Patients May be Unfamiliar with Co-Pays, Referrals

As the Affordable Care Act continues to roll out, physicians around the country have tried to prepare for the expected tide of newly insured patients seeking care.

However, due to the technical problems with both state-based exchanges and Healthcare.gov, insurance enrollment has fallen far short of projections. Given the uncertainty surrounding the rollout of the Massachusetts Connector insurance website, what should Bay State physicians expect?

With the enrollment deadline extended until mid-summer, practices may not notice a dramatic increase in newly insured patients for some time. However, for those new enrollees who do begin to utilize care, the majority will be those eligible for Medicaid and other public programs, or will be eligible for substantial tax credits.

A portion of this population may be unfamiliar with insurance concepts such as co-payments or referrals. Many may not have had regular care in the past. As a result, practices should be prepared to offer guidance to newly insured patients to help facilitate their entry into the health care system.

The Connector is conducting a state-wide outreach and education campaign specifically targeting this population to ensure they can maximize the benefits of their new insurance while also understanding their financial responsibilities, as applicable.

Because the Connector’s IT system has performed poorly so far this year, the state has reverted to processing paper applications by hand. To deal with the backlog, the state received a waiver from CMS to extend the enrollment deadline until June 30.

In the meantime, as of March 1, only 12,965 individuals had enrolled in a plan through the Connector, or only 5 percent of the target enrollment population, according to data reported to the Kaiser Family Foundation.

The impact of the newly insured population on access to care and wait times for appointments remains to be seen. Results from MMS’s 2013 Access to Care Study (pre-ACA implementation) showed stable or shorter wait times in certain specialties.

The 2014 Access to Care Study, due out next month, will provide a snapshot of patients’ experiences with wait times as they grapple with the new influx of patients. Results on this key health reform issue will be reported at www.massmed.org as soon as they are available.

—Leif Brierley
MMS Health Policy Analyst

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