which states still have PPOs?

[FinanceGeek]

PPOs are disappearing from the individual insurance market, in many areas they are no longer sold - on or off the ACA exchange.

Am trying to develop a common theme for where PPOs are likely to survive...

• is it the demographics of the state?
• its regulatory oversight?
• per-capita abundance (or scarcity) of medical providers?
• the presence or lack of "destination" medical facilities like Mayo?
• something else?

I think that avoiding states whose HI plans limit one to narrow networks is going to become yet another key consideration for choosing an ER domicile. Or, maybe we're going to come full circle to the "how to get around pre-existing exclusions" discussions of 10 years ago. That ER folks need to establish a self-employment corporate entity to access small group plans, become students, work at part time jobs with group coverage, etc.

[Update] - removed prior lists of states...

I did find some data on 2016 plan types for each state in this paper:
http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2015/rwjf424457

The paper refers to this site, which has data for states that used the Federal marketplace or infrastructure. There is 2017 data describing the Plan Attributes for the included states:
https://www.cms.gov/CCIIO/Resources/Data-Resources/marketplace-puf.html

 

[cathy63]

California (a few rural regions)

We have a PPO option (Blue Shield) in the city of San Diego. I haven't looked into whether other major cities have PPOs, but if not, then it may be a So Cal / Nor Cal difference rather than metro / rural.

 

[photoguy]

Blue shield PPO is available in every pricing region in CA for 2017. Anthem has a PPO in few areas and EPO everywhere else. (see page 27 of http://www.coveredca.com/news/pdfs/coveredca-2017-rate-booklet.pdf)

I actually don't understand why insurers would even drop PPO plans. Given that they can set the rates so that they achieve a fixed MLR why not offer it anyway (at a higher price)? The only things I can think of is that (1) the insurer is unable to get a good estimate of what the premium should be to achieve the target MLR or (2) the premium would be so high that the company would take a negative PR hit.

 

[msieweke]

Interesting question. I checked 3 locations in GA, including 2 counties in Atlanta. All have only HMO options for 2017.

 

[2017ish]

Notwithstanding all the other health insurance issues in Tennessee, Humana is offering PPO in the three basic ACA flavors to Nashville area residents purchasing through healthcare.gov.

 

[RockyMtn]

Not a single PPO left in Az on or off the exchange. Unless you get PPO through employer coverage you are SOL.

 

[gauss]

I believe that Michigan has PPO choices.

-gauss

 

[swakyaby]

Blue Shield has a ppo plan here in Northern California. Monthly premiums are getting too high, so I'll have to look for something else.

 

[reubenray]

BCBSAL (Alabama) has PPO offers.