The Individual Health Insurance Market continues to improve with smaller rate increases
What is a Gatekeeper Plan and Why is it so important?
Gatekeeper – a form of managed care; it requires the member to get a referral approved from their Primary Care doctor (PCP) to see a Specialist, frequently this requires an office visit to the PCP first.
A plan with a Gatekeeper is intended to reduce frequent/excessive visits to the higher cost Specialist.
No Gatekeeper – allows the member to make appointments directly with Specialist, no referral required.
Ambetter
- No Gatekeeper
- Largest Provider network, including Piedmont, Emory, Northside/St. Joseph and WellStar
- Customer service continues to improve
- Lowest rates of all companies for Silver and Gold plans
BlueCross
- Gatekeeper required in metro Atlanta
- Member must choose a PCP at enrollment and get referrals to Specialist approved before going
- Small Provider network in Atlanta, primarily Northside and Grady hospital
- Competitive rates on Bronze high deductible plans
CareSource
- No Gatekeeper
- New to Georgia, well respected non-profit company based in Ohio
- Solid network in metro Atlanta & Savannah, including Piedmont, WellStar and Northside
- Lowest rates on Bronze high deductible plans with copays for doctor office visits – will be popular
Kaiser
- Gatekeeper staff model – the strictest type of managed care
- Network is Kaiser doctors and facilities only, unless referred out
- Rates are higher than all above companies
Oscar Health
- No Gatekeeper
- Small Provider network
- Highest rates of all plans
- New to Georgia, financial backing from Warren Buffet and Google… not bad
- They will be a non-event in Georgia this year, but stay tuned for next year
