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BCBS withdrawal from much of TN individual market
Old 09-26-2016, 09:55 AM   #1
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BCBS withdrawal from much of TN individual market

Without further comment:

Today's breaking news headline in Nashville, after state approval for 62% premium increase for 2017 (though fed approval still pending), BCBS of TN announces that it is pulling out of the individual markets (both on and off exchange) in the state's three largest metro areas. It is continuing to offer such policies in its home city and in those rural counties that otherwise would have had no individual options available....

BCBST to pull out of Obamacare exchange in Nashville, Knoxville and Memphis
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Old 09-26-2016, 10:14 AM   #2
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That's too bad. Hopefully Tn members affected have other options.
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Old 09-26-2016, 10:23 AM   #3
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At least for now, there will be at least one company offering ACA-compliant individual plans to all Tennessee domiciliaries. BCBS is the biggest gorilla in, at least, middle Tennessee, where the government is located--it is well aware of the optics. :-)

Makes things more interesting for those of us looking to ER next year, especially if one wishes to comply with the law in this area. [Was hoping that if/when they dropped, off-exchange plans would continue in our area.] We'll be switching to DW's health plan from my much cheaper (thanks, to my bosses) plan for 2017. Will pay extra for COBRA eligibility, which will take us through all of 2018--giving more time for market/laws to shake out.

Edited to add bracketed text.
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Old 09-26-2016, 10:50 AM   #4
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BCBS pulled out of the biggest counties in Az as well. We are down to one option in metro Phoenix area.
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Old 09-27-2016, 01:59 PM   #5
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This is really becoming an issue. Those in the individual marketplace could find themselves between a rock (mandated levels of coverage/no high deductible plans anymore) and a hard place (bailing insurance companies/no competition) all against a back drop of zero consensus within the Federal Government. Ugh...
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Old 09-28-2016, 08:59 AM   #6
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Wellmark Blue Cross will not offer exchange plans in SD for 2017.

Quote:
Wellmark says that the decision affects less than 8,000 – or two percent – of Wellmark's members in South Dakota. It does not affect members with plans through their employer or those with Medicare supplement plans.

Reference: Health insurance changes for South Dakota residents
BCBS-NE will not offer exchange plans in 2017.

Quote:
Blue Cross’ individual exchange policies cover only about 20,000 of its 750,000 customers. The decision doesn’t affect insurance covering employee groups, Medicare or Medicaid clients, small businesses and pre-ACA policies. The departure by Blue Cross, which has participated in the ACA marketplace in Nebraska from its start in 2014, leaves only Aetna and Medica Inc. as marketplace alternatives when open enrollment begins.

Another 6,000 people are covered by individual Blue Cross policies purchased outside of the exchange. Blue Cross also will reduce the individual insurance options that it sells outside the public marketplace, dropping its higher-benefit “silver” and “gold” policies but leaving a low-benefit “bronze” policy and a policy that covers only catastrophic health claims. Several other companies also offer individual policies outside the exchange that do not qualify for tax credits.

Reference: http://www.omaha.com/livewellnebrask...caebdcf91.html
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Old 09-28-2016, 09:51 AM   #7
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I read about BCBS of Tennessee pulling out of Memphis, Nashville & Knoxville. They're going to remain (maybe temporarily) in rural areas. That tells you where they've lost $500 million--big cities.

Vanderbilt Hospital's 1700 physicians (and PA's) are not accepting Medicare Advantage plans. They've bought up dozens of private practices and taking management of dozens of hospitals as far away as 300 miles--7 states.

What we're seeing is the demise of the ACA. Something's going to give. It's all going to fall on its face sooner rather than later.

What people don't realize that Nashville's largest business is healthcare. Dozens of companies owning hospitals and insurance companies are headquartered there. Many overseas healthcare and hospitals are managed out of Nashville. There are people there that are capable of designing a healthcare system for the U.S. that would work.
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Old 09-28-2016, 10:55 AM   #8
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Quote:
Originally Posted by Bamaman View Post
I read about BCBS of Tennessee pulling out of Memphis, Nashville & Knoxville. They're going to remain (maybe temporarily) in rural areas. That tells you where they've lost $500 million--big cities.

....

... There are people [in Nashville] that are capable of designing a healthcare system for the U.S. that would work.
My understanding from the press release and news is that the rural areas were spared to avoid leaving counties with no ACA policies at all. BCBS probably lost money there as well--albeit given the sparse population in many of those counties, couldn't have been same magnitude as the metro areas.

As for designing a H/C system that would work for the U.S., I don't see anyone having that capability, whether an executive at HCA or Vandy, or health policy expert economists from Cambridge MA. Far too complex. Akin to being asked to design a system to ensure that sufficient chickens are raised, transported, and butchered to arrive on time and at a set price point at all restaurants and grocery purveyors in the country each day. Not going to happen by an imposed design.
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Old 09-28-2016, 11:41 AM   #9
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BCBS of Tennessee will still offer policies in Chattanooga, so not rural-only. As for the health of the ACA, the Mark Twain quote comes to mind (The reports of my death have been greatly exaggerated). The coverage issues we are seeing are really a weakness in how health care is covered in the US, and can just as easily happen to group coverage. As with the pricing, we see these problems when they affect individual coverage because that's the only insurance that is subject to public and media scrutiny.
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Old 09-28-2016, 01:06 PM   #10
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Another important point to remember for those concerned about "only" one insurance option. It's just like when you were working - you take the employer provided coverage from whatever insurer chosen by the company or you get nothing. In our case it was exactly the same pre-retirement with UHC and post-retirement with UHC through the Marketplace (and the same nearby major hospital isn't in network under either flavor of UHC policy).

We'll only have BCBS in 2017 here in North Carolina, so it's exactly like my options for my entire working career for insurance provided by my employer. BCBS or figure it out on your own.
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Old 09-29-2016, 02:57 PM   #11
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But the problem here is that employer provided insurance usually has better network coverage because it has to cover all employees no matter where they live. And they have leverage with the insurer to keep costs, benefits, and claims payments in line. They have an incentive to keep their employees happy and working for them (I'm talking mostly about MegaCorps of course).

With the ACA under one insurer you could be stuck with plans that only cover you locally with a very limited set of providers, all because you have no choice and no one looking out for you. With almost unlimited out of network liability. And in many states the folks that SHOULD be on your side, the insurance commissioner's office, is not because they oppose the ACA.

With all the bad news about huge rate increases and big providers pulling out of markets, 2017 is shaping up to be a make or break year for the ACA.
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Old 09-29-2016, 03:40 PM   #12
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Originally Posted by GTFan View Post
But the problem here is that employer provided insurance usually has better network coverage because it has to cover all employees no matter where they live. And they have leverage with the insurer to keep costs, benefits, and claims payments in line. They have an incentive to keep their employees happy and working for them (I'm talking mostly about MegaCorps of course).

With the ACA under one insurer you could be stuck with plans that only cover you locally with a very limited set of providers, all because you have no choice and no one looking out for you. With almost unlimited out of network liability. And in many states the folks that SHOULD be on your side, the insurance commissioner's office, is not because they oppose the ACA.

With all the bad news about huge rate increases and big providers pulling out of markets, 2017 is shaping up to be a make or break year for the ACA.

Exactly!


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Old 09-30-2016, 07:52 AM   #13
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TN resident here in a county Blue Cross is dropping. We will still hopefully have two companies but BC was my choice. Scary times and no clarity from DC.

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