What's come into view since then are more complicated challenges from enrollment caps and network limits in the market where about 250,000 state residents buy policies.
In addition, all plans in the market this year feature limits on networks, so patients might not find a plan with low-cost access to the doctors and hospitals they want.
The caps make
"Generally speaking, I think most people on the exchanges continue to be satisfied with their provider networks," said
The caps and network limits come in the state's individual health insurance market, where about 5 percent of state residents buy coverage. It's a market that serves self-employed people, and those who don't get health insurance from their employer.
The limits do not apply to people in employer health plans, or people in government programs including
The individual market is undergoing fundamental changes with the federal Affordable Care Act. It eliminated health plan exclusions for people with preexisting medical conditions, a key cost-saving tactic for insurers.
Insurers have struggled to make the business profitable, with
UnitedHealthcare does not sell coverage in
Regulators said that's why they approved rate increases of 50 percent to 67 percent and enrollment caps.
The caps and network changes will complicate the coming health plan shopping season, said
A year-ago, as consumers were sizing up premium jumps for 2016, some shoppers took a long time to decide about what choice to make to mitigate the impact, Mathson said. With the caps, consumers won't have time to wait.
"If you wait until the end of January to make a decision, there could be very little choice left for you," Mathson said. "If you even wait until December there could be fewer choices."
Blue Plus doesn't have a cap, so its plans will serve as a sort of default option in most counties. But during a legislative hearing last week, lawmakers pointed out that the Blue Plus networks don't include all hospitals and clinics.
In a statement,
Patients can still get care at out-of-network clinics and hospitals with some level of coverage, but they will pay much more out-of-pocket, Mathson said. In particular, whereas health plans put a cap on annual costs for in-network care, there's typically no such cap when patients go out-of-network. So the costs can be prohibitive.
It can all amount to frustration, Mathson said, when network rules point patients away from the doctor or hospital they want.
"There are a lot of people who have developed a relationship with a physician, and they don't want to change physicians just because of health insurance," said Mathson, an insurance agent for more than 20 years who nonetheless has left the business, due in part to all the changes with health insurance.
All the networks were reviewed by regulators and meet adequacy standards. Health plans can make exceptions that give consumers better coverage at out-of-network hospitals in certain cases, said
But those are unique situations, Engel said. In general, health insurers see tighter networks as a way to help control costs through better coordination of care.
"You can't resolve the individual market by just raising premiums," said
Hospitals are watching all this with concern, said
"It really is wise for folks in that marketplace to start to do their shopping early," he said. "And consumers are going to have to be more discerning about what's actually in the plan that they're looking at -- what's that network look like ... [and] what are the out-of-pockets for out-of-network?"
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