Different Ways through which Individuals Can Find a Doctor Accepting their ACA-Plan


Individuals who enrolled in an Obamacare plan on the Marketplace get one step close to access high-quality healthcare. However, after enrollment in an ACA-plan, the next vital step is to find great doctors or in-network healthcare providers accepting their health plan. So all the individuals looking to find a doctor who accepts Obamacare plan can go through this post.

Know about in-network Healthcare Provider

Finding a doctor who accepts ACA-plans for individuals is just like checking if a doctor is in-network of their plan or not. Individuals need to find a doctor who is in-network for their plan. First, it is important to understand the meaning of in-network. In the health insurance sector, companies sign a contract with certain doctors, hospitals, and other health-care professionals to provide healthcare at a negotiated price to all people who have purchased health insurance from them. Thus, all such doctors and hospitals who have agreed upon to provide medical services at the negotiated prices to members are considered as in-network providers.

Narrow or Limited Network

Health insurance companies that comply with Obamacare standards generally keep limited or narrow networks of healthcare providers and hospitals, who agree to provide medical services at lower negotiated prices. Health insurance companies usually have limited in-network healthcare providers so that they can keep the monthly premiums of the plans lower. Health insurance companies have a contractual relationship with a network healthcare provider and this relationship establishes care standards, clinical protocols, and fixed charges for specific services. In return, the healthcare providers gain several patients and a primary care physician receive a capitation fee for every patient assigned to him or her.

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How to Find an in-network Provider?

There are several ways through which individuals can check if a given doctor is in-network or not. Doctors often practice at different facilities and all locations are not covered under every plan, so individuals need to make sure that they visit the right office or they can have to pay higher bills.

  • Individuals can call on the phone of the healthcare provider’s office to confirm whether they take their specific health plan or not. Individuals need to have their insurance card on-hand while confirming it with the doctor, as they will need to provide their member ID number and the full name of their plan.
  • Individuals can also find an in-network doctor by checking at the health insurance company’s website. The health insurance companies’ websites have search tools that allow individuals to enter their plan name and then search for the providers who accept that ACA-plan. Individuals can also make a call to the member services department of their respective insurance companies. Individuals can also make a call to the insurance carriers, who check whether a specific provider is in-network of a plan or not by looking up their specific tax ID number. Individuals can have access to their doctor’s tax ID number by making a call to their doctor’s office and asking for their specific doctor’s tax ID number.
  • Some of the health insurance portals are another useful resource that individuals can make use of to find in-network healthcare providers of their plan. People can create a no-cost, and no obligation account at these websites, whose search functionality will allow them to automatically find healthcare providers that are in-network with their plan.
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Benefits of Visiting In-Network Doctors

People need to visit an in-network doctor because they benefit from the negotiated payment rates that the insurance company and doctor have agreed upon. Due to this people can access healthcare services at lower prices when they visit in-network doctors for obtaining medical services. If they visit an out-of-network provider for obtaining healthcare services, then they will require to pay the entire healthcare cost from their pocket.

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