For health plans that require enrollees to select a primary care provider, the ACA sets a new standard allowing enrollees to have a choice of any primary care provider accepting new patients in the plan's provider network. In other words, unless the enrollee neglects to select their primary care provider, the plan may not select one for the enrollee. In addition, if a child is enrolled in a plan that requires a primary care provider, the ACA gives enrollees the right to choose a pediatrician as their child's primary care provider. The law also guarantees direct access to in-network OB/GYNs for women in health plans that require them to designate primary care providers (in other words, not requiring prior authorization or a referral).
Consumer Protections in the Affordable Care Act
Access to Choice of Providers
ACA Provisions »
- ACA Basics
- Individual Requirement
- Employer Requirements
Health Insurance Exchanges
- How would individuals or businesses buy insurance in an Exchange?
- What will the Exchanges offer?
- What are an Exchange’s responsibilities?
- How will Exchanges coordinate with state Medicaid and CHIP programs?
- How can Exchanges hold health plans more accountable?
- How do Exchanges improve health plan quality and value?
- Consumer Protections in the Affordable Care Act
- Setting Premiums
- Essential Benefit Package
- Coverage Tiers