Texas Dropping PPO Plans for 2016

15 Sep, 2015

Texas Dropping PPO Plans for 2016

Open Enrollment For Individuals Is November 1, 2015 – January 31, 2016

If you are looking to buy your own health insurance plan or change your current coverage for 2016, you can do so during this time.

In order to help you better understand your options for 2016, I will highlight the current status of each insurance company we represent in Texas. Today I’m featuring Assurant and Blue Cross Blue Shield of Texas (BCBSTX).

What to Expect for Health insurance Open Enrollment 2016

Assurant has had enough and is getting out of the health insurance business. Here is an excerpt from their press release that sums it up.

NEW YORK, June 10, 2015 – Assurant, Inc. (NYSE: AIZ) has concluded a comprehensive review of strategic alternatives for its health business and will exit the health insurance market as the Company sharpens its focus on housing and lifestyle specialty protection offerings. The Company expects to substantially complete its exit of the health insurance market by the end of 2016.

Therefore, if you have a policy with Assurant and you have not received your cancelation notice, you will soon. You can select another company during open enrollment or during a special enrollment period when the policy is canceled.

BCBSTX took it in the shorts in 2014, paying out more than $400 million more in claims than it collected in premiums in the individual market segment. In order to succeed in the new health insurance market, BCBSTX is making some bold moves.  In their newsletter to agents they made the following statements:

There are some changes in the plans we intend to offer in 2016. Most significantly, we won’t be offering our Blue Choice PPO insurance plans for our under 65 block of business going forward. BCBSTX paid out more than $400 million more in claims than it collected in premiums in the individual market segment in 2014. Losses that high are unsustainable, and we have adjusted our offerings – as many insurers have – to be sustainable in the new market reality.

  1. Why is BCBSTX discontinuing the Blue Choice PPO?
    For the past two years, BCBSTX has been the only health insurer offering an individual PPO plan in all Texas markets. BCBSTX found that the PPO is not sustainable at an affordable price due to anti-selection. BCBSTX will continue to offer other plan options in all 254 Texas counties, on and off the Marketplace.
  2. What will this mean for individual members who currently have the PPO plan?
    BCBSTX will be transitioning affected individual members to another plan, so you will not experience a gap in coverage. You will also have the option of choosing a different plan during 2016 open enrollment.

Currently, BCBSTX has two provider networks for individual plans: Blue Choice PPO and Blue Advantage HMO. Some providers are only in the Blue Choice network, and some of them have decided not to join the Blue Advantage HMO network in 2016. Therefore with the Blue Choice PPO individual plans going away, these providers will no longer be an in-network option for most of our individual members. If you have a grandfathered plan, you will still have access to the Blue Choice network.

I have found the Blue Advantage HMO network to be limited and would not assume your current provider will take the Blue Advantage HMO network.  I would suggest talking with all your providers to confirm what HMO networks they will be participating in 2016.

In 2015 Assurant and BCBSTX were the only two insurance companies that offered true PPO plans in the Texas individual market, so unless something changes there will no longer be any PPO plans available on or off the exchange for individual in Texas in 2016. Just as predicted, we continue to see shrinking networks for individuals to access providers.

Next time I will continue discussing BCBSTX and take a peek into what Cigna is doing for 2016.

Take Care!

Greg Downing

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