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BCBSTX Canceling PPO Plans for 2016
Old 07-24-2015, 06:22 PM   #1
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BCBSTX Canceling PPO Plans for 2016

Heard on the TV news tonight that BCBS of Texas is canceling PPO Plans for 2016, unless the plan is through an employer. They claim it is too costly. Does not sound good for ACA coverage in Texas, although an HMO plan will supposedly be offered, although as I understand it, Dr acceptance of the HMO is limited. Not sure if this will go beyond Texas or not.

I have DD covered under a PPO Gold Plan, so guess it will be time to shop for something else. Hopefully, this does not extend over to my medicare Supp F plan.
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Old 07-24-2015, 06:35 PM   #2
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Wow! - I found this: BlueCross BlueShield of Texas to drop individual PPO plans in 2016 | | Dallas Morning News

We're screwed!

If DH had stayed with his old PPO plan, he would have been able to keep it. But he switched to a new plan for HSA eligibility, plus the rates were lower even with the same deductible.

This is pretty mind blowing!!!
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Old 07-24-2015, 07:15 PM   #3
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Will other insurers be offering PPO plans? I've had both and prefer PPO but HMO was ok (albeit long ago for us).
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Old 07-24-2015, 07:30 PM   #4
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Who knows? I guess we have until October to find out. We don't know what companies are offering for 2016 until the plans are announced.

Here is the announcement on the BCBSTX site: Alerts and Announcements | Blue Cross and Blue Shield of Texas - What to Expect for Open Enrollment for 2016 Plans

Here is an important section quoted:
Quote:
What will be different for individual plans in 2016?

There are some changes in the plans we intend to offer in the individual market in 2016. We won't be offering PPO insurance plans in the individual, retail market. However, we intend to continue to offer HMO plans. This change does not affect our employer group customers or the grandfathered PPO individual plan members.

Why is Blue Choice PPO going away?

BCBSTX was the only insurer to offer an individual PPO insurance plan across the state to individuals in 2014 and 2015. Since the Affordable Care Act began, the market has changed. We found that the individual PPO plan was no longer sustainable at the cost it was being offered. Because we want to make sure that our plans are affordable, we decided to not offer individual PPO plans in 2016.

Why couldn't you just keep offering the individual PPO plans and raise the rate for them?

The law requires that we set our individual plan rates based on all of our individual members' claims history. This means that if the costs of one plan are high, it will raise the rates of all other plans, not just the high-cost plan. If we kept the Blue Choice PPO, this would have raised the rates so much for all our other plans that most people wouldn't be able to afford them. By dropping the PPO, we can still offer our other plans at reasonable rates.
OK - that last paragraph is still blowing my mind.

Open enrollment doesn't start until Nov 1, 2015. Policies available should be announced before then. I guess we'll be getting letters in the mail.

What's crummy is dropping out of a big section of the individual health insurance market. Seems like we're going right back to where you can (maybe) get a health plan through your employer, but if you are an individual, your options are extremely limited.

How would you ever know. But DH had a grandfathered plan, but we didn't keep it. We didn't expect to lose the option to have a PPO.
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Old 07-24-2015, 07:41 PM   #5
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Is BCBSTX a non-profit or has the brand been acquired by one of the for-profit insurers as has been done in other states?
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Old 07-24-2015, 08:01 PM   #6
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Is BCBSTX a non-profit or has the brand been acquired by one of the for-profit insurers as has been done in other states?
No - it's not a non-profit, and I don't believe it has been acquired.
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Old 07-24-2015, 08:04 PM   #7
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Will other insurers be offering PPO plans? I've had both and prefer PPO but HMO was ok (albeit long ago for us).
It depends on the county.

When I was shopping late 2013, Assurant/Aetna and Humana were available for my county. But not every county is covered as far as I know.
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Old 07-24-2015, 08:11 PM   #8
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It seems strange/silly that insurers can cherrypick counties. I would think that state regulators would tell them to either cover the whole state or nothing. I would think that Texas would have the heft to demand that.
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Old 07-24-2015, 08:18 PM   #9
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Originally Posted by audreyh1 View Post
Wow! - I found this: BlueCross BlueShield of Texas to drop individual PPO plans in 2016 | | Dallas Morning News

We're screwed!

If DH had stayed with his old PPO plan, he would have been able to keep it. But he switched to a new plan for HSA eligibility, plus the rates were lower even with the same deductible.

This is pretty mind blowing!!!
One problem I can see with those old grandfathered plans is that many don't accept new members so the group gradually gets older and sicker and so premiums would have to go up to reflect that.
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Old 07-24-2015, 08:21 PM   #10
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It seems strange/silly that insurers can cherrypick counties. I would think that state regulators would tell them to either cover the whole state or nothing. I would think that Texas would have the heft to demand that.
Not in the Wild West, Cochise County is closely the size of the States of Rhode Island and Connecticut combined.

ttps://en.wikipedia.org/wiki/Cochise_County,_Arizona
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Old 07-24-2015, 08:29 PM   #11
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It seems strange/silly that insurers can cherrypick counties. I would think that state regulators would tell them to either cover the whole state or nothing. I would think that Texas would have the heft to demand that.
I think in most states, insurance regulation is more for show than anything else. Insurance companies pretty much get their way unless there's outright fraud involved.
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Old 07-24-2015, 08:41 PM   #12
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Wow.... so on top of a 24% increase in my premium last year... I now have to look forward to another large increase and a worse plan.... and I already went to a worse plan last year because of price...


None of the other options were cost effective... the only hope is that the second lowest silver plan is pretty high and the subsidy goes up....


It would be sad, but I might have to go to work for insurance.... I do temp work, but nothing offered to me this year has been good, so I have not worked...

I am starting to think single payer is going to be the way to go.... never would have thought I would be saying that....
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Old 07-24-2015, 09:05 PM   #13
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Originally Posted by DFW_M5 View Post
Heard on the TV news tonight that BCBS of Texas is canceling PPO Plans for 2016, unless the plan is through an employer. They claim it is too costly. Does not sound good for ACA coverage in Texas, although an HMO plan will supposedly be offered, although as I understand it, Dr acceptance of the HMO is limited. Not sure if this will go beyond Texas or not.
Oh no!! This is terrible. I am so sorry to read that this is directly affecting some of us.
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Old 07-24-2015, 09:12 PM   #14
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What's crummy is dropping out of a big section of the individual health insurance market. Seems like we're going right back to where you can (maybe) get a health plan through your employer, but if you are an individual, your options are extremely limited.
And, the tremendous amount of merger activity in the health insurance sector will also decrease the number of players and the choices available.

It's too bad that the way the law's pricing calcs work, BCBS apparently couldn't continue to offer a product people wanted, even though those choosing it might have been willing to pay a higher price for it.
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Old 07-24-2015, 09:39 PM   #15
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When I looked at the plans on the NY Exchange last year, I don't recall seeing any PPO. I'm still getting insurance through my w**k, but that was a surprise about the exchange plans. Maybe I missed one, but I don't think I could find one.
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Old 07-24-2015, 09:40 PM   #16
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So they had a bunch of expensive people on the PPO and decided to shed the load...

They should be able to start fresh in a year or two, I would guess, and try for a better mix.
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Old 07-24-2015, 10:01 PM   #17
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Not in the Wild West, Cochise County is closely the size of the States of Rhode Island and Connecticut combined.

ttps://en.wikipedia.org/wiki/Cochise_County,_Arizona
Ah, grasshopper.... you think size matters? That is so old school.

BTW, the population is ~3% of the population of Connecticut and Rhode Island combined.
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Old 07-24-2015, 10:51 PM   #18
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My biggest concern it that I think that my insurance will double in cost in a two year period.... most of the other plans that were offered were $200 to $500 more per month.... Heck, I think that I am in an HMO no because of the big increase this past year... and mine still went up 24%.....
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Old 07-25-2015, 07:17 AM   #19
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This is unfortunate. I wonder what led to this, and why an HMO is such a better option for them.

This will impact the rollout of the multi-state plans.
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Old 07-25-2015, 07:34 AM   #20
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This is unfortunate. I wonder what led to this, and why an HMO is such a better option for them.

This will impact the rollout of the multi-state plans.
My suspicion is that the recent announcements of the various health insurer mergers contributed in part to this.

HMOs? Perhaps better able to directly control their costs and lower their risk.
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