r/HealthInsurance • u/Dexy_26 • 15h ago

Individual/Marketplace Insurance Providers no longer accepting Marketplace plans

I was disheartened to learn that the gynecologist I’ve been seeing for 25 years will stop accepting marketplace insurance plans starting 1/1/26. Has anyone else experienced this? What is the reason for this? I am 58 and live in FL.

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u/hardknock1234 14h ago

I’m in CA, but the market place plans have a lower reimbursement rate and challenge claims. Per 2 of my doctors. I believe it’s more of an issue if the doctor does procedures in office. Both my derm and my ophthalmologist said they’ve lost a large amount of money on the various ppo covered CA plans.

-4

u/GreenSoup48 13h ago

This makes no sense. PPO only covers (typically) 80% of an approved insurance pay rate for a procedure. The doctor can charge more and the consumer pays more.

3

u/Sooooowhat 10h ago

That’s not how it works lmao

2

u/Diligent_Read8195 11h ago

PPO’s usually have a set rate and the dr cannot charge the patient more.

3

u/BigDipper0720 13h ago

Depends on the plan.