How Will Obamacare Affect Podiatry?

Neal Frankel, DPM, FASPS, FACFAS

   A health insurance exchange is a marketplace for purchasing health insurance. Accordingly, we could call them exchanges or marketplaces, and we would be talking about the same thing. The official term when talking about Americans using the exchange is a “health insurance marketplace.” Each state-run exchange has its own unique name.

   The health insurance exchange is also known as the HIX, the Affordable Care Exchange, the Health Benefits Exchange, the Health Care Exchange, the Health Insurance Marketplace and Affordable Insurance Exchange. The terms are all interchangeable, just like Obamacare is also called Health Care Reform, the Affordable Care Act, ACA, etc.

   The ACA health insurance exchanges allow all Americans above the poverty line to be able to buy health insurance through providers via an online health insurance marketplace. The health insurance marketplace works similar to a car insurance Web site that displays side-by-side cost and benefit comparisons of different tiered plans to help the shoppers purchase the best coverage for them and their family.

   Each healthcare provider will try to attract customers by providing affordable quality healthcare packages.

   People will be able to compare coverage options using an online calculator to figure out which plan is right for them.

   By enrolling in the exchange, participants will automatically see prices that reflect their savings after tax credits. Please note only those making under 400 percent ($90,000) of the federal poverty level ($11,000) will be eligible for tax credits.

   The Department of Health and Human Services administers the requirements for the exchanges and the health plans that can be sold on the exchange. This measure of quality assurance ensures that any plan people buy on the exchange meets certain requirements, increasing consumer protection.

A Guide To ‘Qualifying Health Plans’ For The ACA

There are four tiers of “qualifying health plans” patients or their employer can purchase on the exchange. They range from lower quality but more affordable “bronze plans” to “silver plans” to a more expensive plan with better coverage called a “gold plan.” There is also a “platinum plan,” which is the highest quality and cost plan. Lower premium plans will have higher deductibles, fewer benefits and larger out-of-pocket costs.

   Qualifying health plans are plans that meet the minimum standards set forth by Obamacare. All plans sold on and off the ACA health care exchange must include the following to be considered a qualifying health plan:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services, and chronic disease management
10. Pediatric services, including oral and vision care

   Now the reason you are hearing about premium increases and individuals losing their coverage as plans dropped them is because the plans did not meet the criteria of coverage listed above. If you consider that everyone will be paying increased premiums to provide coverage for these additional services, the only way the insurer can be profitable is to reduce the size of certain networks and charge greater deductibles on these plans.


Nice Article! Going with my practice regardless of Obamacare.

With ACA & ICD-10, now more than ever podiatrists need to start changing the way they practice.

Ten years ago, I walked away from the limitations of insurance and started conducting clinical trials. I have never looked back! The majority of clinical trials in the field of foot disorders, foot care and treatment of lower extremity disorders are being conducted by MDs and DOs. Podiatrists are considerably highly qualified and can be considered as experts in the disorders and treatments related to the lower extremity. However, the majority of podiatrists are not taking advantage of the large number of clinical trials available to them.

By incorporating clinical research into your private practice, you increase the value of your business and by that I mean increasing your revenues, profits and equity should you decide to sell your practice or exit in some way.

It's time for podiatrist to discover the lucrative world of clinical research. If you are interested in learning how to incorporate clinical trials in your practice, send me an e-mail.

Michelle Alex, DPM

I would be very interested in learning more about the clinical trials.



I'd like info about conducting clinical trials. Thanks.


Send me an email and we can talk.

It's a sad day. I voted Democrat thinking that Obamacare was great to offer everyone insurance. I have type 2 diabetes, $300,000 in student loan debt and I am in private practice. I have managed to run a successful practice for 10 years, based strictly on quality patient care and superior customer service with a top of the line EMR. Due to low reimbursement, increasing overhead and the constant battle to fight and justify to be paid for my service and product, I'm not sure how long I can hold on. Is the private practice doctor being eliminated slowly? I did a 1-year residency, which included a good mix of medicine and surgery, but I am unsure of my future. I LOVE my job! I am sooooo disheartened about the future of podiatry! Any words of wisdom would be appreciated.

My email :

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