HealthCare.gov Pilots New Doctor Lookup Feature

CMS NEWS FOR AGENTS AND BROKERS

November 3, 2015                                                                                                                          

Contact: CMS Media Relations

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Beginning today, HealthCare.gov is piloting a new beta feature that allows consumers to search plans by their preferred provider or health facility. Some consumers will be part of a pilot that allows them to use the beta Doctor Lookup feature as they compare their coverage options in window shopping or when selecting a plan.

“The Doctor Lookup feature at HealthCare.gov is a direct result of consumer demand,” said Kevin Counihan, CEO of the Health Insurance Marketplace. “Our goal is to provide consumers with relevant, personal and more up-to-date information about a plan before enrolling. We thank the Marketplace health plans who have now made this information available to the public.”

This phased-in approach will reach about one in four visitors to HealthCare.gov – selected at random – allowing us to examine the consumer experience with the feature and to analyze the quality of the data based on consumer feedback as we finalize the feature and determine how best to meet consumer needs. In this early stage, some data will be missing or may be inaccurate. As of today, HealthCare.gov has access to data from over 90 percent of insurance companies on the Marketplace. If an insurance company has not provided validated data, consumers will be alerted when they search for a provider that there is “no data from insurance company.” CMS will continue to provide technical assistance to insurance companies that have not yet provided access to their data and will update HealthCare.gov on a daily basis.

Consumers are reminded that health plans can change which doctors and facilities are in their network on a continual basis and providers can change locations and affiliations frequently. That is why we’re encouraging consumers to check with their doctor or plan to confirm that the doctor accepts that plan. Consumers will be asked to opt-in to use the tool to be sure they understand limitations with the data and will be able to leave comments directly through the site.

For the first time, insurers are required to provide up-to-date information about which doctors and facilities are in their networks. Plans must also provide access to information on what medications are covered in the health plan formulary. In the coming weeks, HealthCare.gov expects to pilot the Prescription Drug Check feature, as well, which will allow consumers to search for whether a plan covers their prescription drugs.

"The future for CMS is to create an open-source environment that drives innovation for the consumer. By requiring data transparency from health plans and providers and by releasing the information in a machine readable format, we are using consumer demand to accelerate that change," said CMS Acting Administrator Andy Slavitt. "This fits in with our strategy and should make experiences like Marketplace Open Enrollment better for consumers."

CMS accesses the provider data from the health insurance websites and updates this information daily, for both HealthCare.gov and to make the information available publicly for app developers. On Friday, CMS released this data in a format that will help fuel public and private innovation among health care app developers.

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