As independent professionals, the partners at Capko & Morgan have purchased insurance privately for many years.  I’ve been a member of my HMO for 20 years, and have been paying for it myself as a small businessperson/independent professional since 2001.  I had a good plan that seemed to generously exceed all of the ACA requirements, and then some — I was very satisfied with it.  Unfortunately, that wasn’t sufficient to protect me from cancellation.  I was notified about a month ago that I had been shifted into an exchange plan that is significantly more expensive, with huge increases in copays and deductibles, and numerous excisions of benefits I valued that I would now have to pay for 100% out of pocket.

Now, lest you think this little anecdote has nothing to do with the headline for this post, let me get to the point.  Like so many others in my predicament, I’m pressed to look at options.  I have never in my adult life contemplated doing without a comprehensive health plan.  But, I have heard from others in my position that they’re considering ‘going naked.’  The logic?  Paying for coverage that doesn’t really kick in until you’ve paid about $11K into the system might make less sense than paying cash, then signing up for coverage in the unfortunate event you’ll actually need to use it.  For some people who lost much lower-priced, catastrophic-only coverage, the financial realities are even more stark — they just may feel they cannot afford to pay thousands of dollars more each year for coverage, even though they may receive considerably greater benefits in return.

If a significant proportion of the independently insured population opts to pay the ACA penalty instead of purchasing or continuing to purchase coverage, what might that mean for your medical practice?  One possibility is that more people will want — or need — to pay cash for services.

For primary care and urgent care practices, this means it’s more important than ever to set up your cash-only fee schedule — and to let patients know that it’s available.  Cash pay could be a real opportunity for primary care practices — and you should be prepared to take advantage of it.  But, what’s perhaps less obvious is that specialties might benefit from establishing or revisiting their cash-only fees as well.  Specialist office visits and even minor procedures could be funded by patients at lower cost to them than joining up with an exchange program, depending on their individual circumstances and the state that they reside in.  (And, of course, people ‘opting out’ will be rolling the dice to an extent — and may need to have a more expensive service before the open enrollment period comes back around.  This is yet another reason to have a cash program in place.)

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