Obamacare may be changing the health insurance system, with 8 million Americans enrolled through the online exchanges, but behind the booming statistics is the thorny decline of medical and health practice.

The online exchange on health insurance is a form of a virtual marketplace set up under the Affordable Care Act. The Obamacare exchange targets the young and uninsured, so even if you already have an employer-provided health insurance but wants to switch, you “may not qualify for some of the benefits that the uninsured have,” says E. Denise Smith, a professor of health care management at Gardner-Webb University in Boiling Springs, N.C.

The complication of the new healthcare landscape set by Obamacare may have just made seeking medical service and professional practice in medicine and health so confusing. It has caused major changes in standard protocol that made the service more demanding, causing delays in patient care.

In obstetrics, referring a patient to a specialist seems so much bigger a deal than it actually is, almost impossible if I may say. The options for referral have become so limited that when a patient needs the services of another specialist- a hematologist for example because of abnormal blood count- I have no choice but to pick someone from the list even if, just for instance, my professional judgment tells me to go for someone else.

Obamacare may be rising in popularity with the consumers, but there are still a lot of physicians and specialists who do not accept Obamacare. If you’re trying to refer a patient to someone who does, chances are that specialist can be found farther away from where the patient originally is. This creates an undesirable cascade of referral after referral, only to end up with the patient getting less than what he or she needs.

Indeed the Obamacare system appeals greatly to many consumers. But what do we do with insurance if there is no doctor who will accept it? It seems as though this is just a case of covetous practitioners trying to get more money from unsuspecting patients. The truth is, physicians are humans too and there are practice related bills that needs to be paid. Over the years, reimbursement rates from basic insurance plans have drastically gone down so a lot physicians and private practitioners opted out of the Obamacare.

These are instances to consider before purchasing health insurance, be it private or federal provided. Under the law, if your share of the premium costs more than 9.5% of your household income (ex. earning $40,000 a year and paying $3,775 for individual coverage), your plan is considered unaffordable. You don’t get lower cost if your 2015 estimated income is above $46,680 for an individual and $95,400 for a family of 4. Therefore, you are not eligible for government subsidy to help pay your insurance. Now subsidies, are what makes Obamacare most appealing.

However, even with subsidy, many people still find the cost of insurance unaffordable. Major medical plans are still expensive now, even with Obamacare, because of added benefits you may not need or want as well as the fact that older and sicker people can purchase them. This causes an increase in the cost of 40-60%.

Buying outside the marketplace does not necessarily mean higher prices, especially if you don’t get subsidy with Obamacare anyway. With the help of an insurance agent or broker, you can easily find a health plan that’s right for you by comparisons of plans based on features and prices that you want. Agents are generally paid by insurance companies so there is no need to pay more for their services.

At first glance, Obamacare looks not at all misleading. However, there is no fixed premium as the number of enrollees steep and coverage for pre-existing conditions increases. It won’t hurt to look outside before settling for something, especially if it concerns your health.