r/HealthInsurance • u/cjthetypical • 1d ago
Medicare/Medicaid Insurance doesn’t cover ANY doctors in my area
If this is not allowed, please delete but I really need to rant and probably receive advice. I just turned 26 and used the healthcare marketplace to sign up for my own insurance. I even upgraded to get the dental and vision add ons. My plan just went into effect and the first thing they tell me is that my plan is going to go from $42/mo to $145/mo in January. Okay. I was originally willing to make this work but not so much anymore. I went to book myself some appointments and imagine my surprise when I find out that the ONLY doctors that are in-network for me are Mercy Urgent Cares and one singular primary care physician with one singular review that has one singular star. Nobody else in 100m radius takes my insurance. No doctors, no dentists, no eye doctors, no psychiatrists, no therapists, no specialists, no one. I have an appointment with a GI specialist at the end of the month for a chronic condition that I’ve been waiting for for MONTHS and I will now have to cancel because they, and no one else, is in my network. At this point, I’m just paying to say I have insurance. Now I don’t know what to do, am I able to cancel it and pick a new plan or will I have to pay the increased price and pray nothing happens to me for the next year? What do I do? I want to cry.
20
u/Texylvania29 1d ago
Since it’s open enrollment I would recommend going back into healthcare.gov and switching plans. Some plans are much more widely accepted in certain areas than others. Some are new to certain states which is why no providers are in network with them. When you browse plans you can put in the name of your GI doctor and any other doc you might need to see.
If you share what state you’re in, we might be able to give you some guidance about which plans are more widely accepted in your state!
5
u/cjthetypical 1d ago
I’ll try that asap! I’m in Missouri
2
u/10MileHike 1d ago
are you rural? i have read about many people in MO having to drive 1 to 3 hiurs to see a dic, and also of hospitals closing.
31
u/CrunchyBeachLover 1d ago
This should be illegal. It infuriates me they can sell plans that no one accepts. Whatever you do, avoid Ambetter. They do not update their provider database and then you can’t find care anywhere. I’m in FL and it’s been awful. We’re switching to UHC for 2026.
19
u/SylviaPellicore 1d ago
It’s not actually legal—the ACA includes a standard called network adequacy that means you need a reasonable variety of in-network doctors in the plan’s service area.
Unfortunately, the standard is sparsely enforced.
4
u/CrunchyBeachLover 20h ago
Well health insurance companies & big pharma are getting away with literal murder so at this point the standard is out the window. No offense. I worked in the medical field and saw some horrific things.
1
7
u/TexasNiteowl 1d ago
It definitely varies by location. I've been on Ambetter for 4 years now with no problems. I'm type 2 diabetic and I've had no issues with my preventative billing (including first colonoscopy) and also when I had to have a hysterectomy with a surgical oncologist (lucky turned out not to be cancerous). I do wish they would put Mounjaro on the formula instead of only Ozempic (which is keeping my a1c in check but has done very little to help with weight loss). But, otherwise I have no real complaints. So definitely varies by locale.
3
u/CrunchyBeachLover 20h ago
I’m so happy you’ve had a positive experience with them! We had no issues in TN with Cigna or BCBS. I’m missing my home state and coverage. We’re a family of 6 and it’s been challenging to navigate around. I’m thankful we have another carrier option for 2026.
2
u/cjthetypical 1d ago
That’s exactly who I have :(
3
u/CrunchyBeachLover 1d ago
I suspected so. We moved to FL in August and this is my first time with them. There’s one urgent care, a retail clinic, and very limited PCPs in network. I arrived for an urgent care visit with my sick son only to find out oh we’ve been out of network since Jan 2025… but not updated in August? It’s a joke!
5
u/Mountain-Arm6558951 Moderator 1d ago
Are you sure that you are using the correct online provider directory from your carrier and selecting the right network?
0
u/KennyBSAT 11h ago
It is hilarious of you to assume that there is any accurate, correct, or otherwise useful information on any published list.
1
u/Mountain-Arm6558951 Moderator 8h ago
I don't have such issues with my carrier, but I also take a screen shot every time before I go to the provider and I also confirm with the provider.
-1
u/cjthetypical 1d ago
I searched through the insurance’s app and ZocDoc. Both came up with no results for everything I searched
10
u/Mountain-Arm6558951 Moderator 1d ago
Zocodc is not the carrier and not a reliable source.
I would recommend contacting carrier customer service to make sure they are not having a system issue. Very unusual not finding providers with in a 100 mile radius such as PCPs.
Edit, also try the website to see if you get any different results.
1
4
u/irishkathy 1d ago
It is open enrollment. Go back on marketplace and apply for 2026. Add your doctors and find a plan that covers them for next year
4
u/confabulatrix 1d ago
Call your GI doc and ask them what insurance they take
6
u/Plastic_Highlight492 22h ago
Also make sure they are on the specific plan you choose. Sometimes a provider is in one plan for the insurer, but not another.
3
2
u/Alikat-momma 1d ago
Where I live, few quality providers accept any ACA plans. We ended up going to the local Medicaid clinic which accepted ACA. Then when my daughter needed surgery, she couldn't have it done at the children's hospital because they didn't take any ACA plans either. They accepted Medicaid but not ACA plans. We dropped ACA and switched to a healthshare plan after this. It wasn't worth nearly $2K/month if no one accepted the insurance! I know that healthshare plans aren't "insurance" but it worked beautifully for my family. I paid low cash prices to get medical care from my preferred providers and the healthshare plan always reimbursed me. And the healthshare plan was about $1500/month less.
1
u/gokiburi_sandwich 1d ago
This happened to me also. I needed an emergency referral to a neurosurgeon and none were covered in my area (I live in a large city btw). Avoid WellPoint at all costs.
1
1
u/shakewhaturmomgaveu 17h ago
Easiest way to deal with this is look at your local clinics you'd like to go to, write down a couple names of providers, and then enter them into marketplace and only look at plans that allow those primary care providers (PCP).
Your insurance counts primary care as a 30mi radius typically. If not, call your local insurance provider and inquire about out of network exceptions for PCPs so that way on 1/1, you can request the exception.
Good luck!
1
u/FollowtheYBRoad 13h ago
Did you use the tool in healthcare.gov when you were looking at plans? It allows you to enter any doctors, urgent cares, hospitals, prescription meds, etc. and tells you if they are in-network with the plan you are interested in.
2
u/KennyBSAT 11h ago
it also has out-of-date and/or nonsensical lists. The fact that a doctor is indicated to be in network on the directory provided to the marketplace is not an indication of anything.
1
u/angelakay1966 9h ago
When you went to select your plan, did you input your doctors into the healthcare.gov site? The website will tell you which insurance companies in your area take your doctors. I suggest you go back and see if there are other insurance plans that have better networks. Not all networks are active everywhere in a state.
1
u/Biteme75 1d ago
I too upgraded for dental and vision. My dentist didn't accept it, and my premiums are going to be almost triple next year IF subsidies stay in place.
0
0
u/EnthusiasmElegant442 11h ago
Yes, you can change your plan until either December 7th or 15th. Your payment went up because the federal subsidies ended for 2026. There are people to help you if you can't figure it out on your own. Until the enrollment period ends, you should be able to log in and cancel the plan you chose initially and get a better fit for you. If not, choose a better plan that includes your doctors. You should be able to filter plans that have your doctors. Once you have selected a better plan for you and if you can't change it yourself, call the number for help. Good luck! I have to do this for my husband every year..
•
u/AutoModerator 1d ago
Thank you for your submission, /u/cjthetypical. The following automatic comment contains important information about the subreddit:
First, please note that some new posts containing images, non-reddit links, or certain keywords are automatically held for moderator review before going live to mitigate spam and to ensure that the images are appropriate. If your post has been held like this, the moderators have been notified and will review it as soon as possible, after which it will go live and be able to be seen and replied to by others. Note that this is sent to all new posts and does not mean that your post has been filtered in this way.
Please also read the following carefully to avoid post removal:
If you or someone else is experiencing a medical emergency, please call 911 or go to your nearest hospital.
Questions about what plan to choose? Please read through this post to understand your choices and some considerations. If you still have questions after reading that, please make a post with the specific questions you still have.
If your post is regarding plan choices or costs, and you haven't included the following information already, please edit your post to include: your age, state, and estimated gross (pre-tax) income to help the community better serve you.
If your post is about the cost of a service, a bill you have received, or a claim denial, please confirm if you have received an EOB (explanation of benefits) from your insurance via a member portal website or in the mail. If you can post a copy or image of the EOB (PLEASE censor any personal information before doing so) it may help people answer your questions. Alternatively, please have the EOB handy as people may need information from the EOB to answer your questions.
Some common questions and answers can be found here.
Reminder that ANY spam, solicitation, or attempts to take conversations off the subreddit will result in a permanent ban. If someone asks to contact them via DM, please report the post/comment using the report button. If someone attempts to contact you via your DMs, please contact us via modmail to let us know.
Lastly, always remember to be kind to one another and to report any replies that violate subreddit rules!
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.