As the health insurance enrollment season opens this week you may see big changes in your plan if any plan at all. Blue Cross Blue Shield of Texas, Oklahoma, Illinois, and possibly other cities are all discontinuing all PPO plans for individuals and families at the beginning of the year. In Texas alone it will affect around 367,000 people statewide. The company claims it paid out $400 million more in claims than it collected in premiums for its Blue Choice PPO product in 2014, the first year of open enrollment.
To add more salt to the wound the competitor Humana will no longer will sell any PPOs on HealthCare.gov, the only place where shoppers can get tax credits for individual or family coverage. The company said the change was necessary to preserve the “affordability and access” of its other health plans.
Some Blue Cross HMOs such as the Blue Advantage Plus plans will feature an added benefit in 2016 that allows some coverage if a policyholder goes out of network. Consumers will pay a higher premium for these HMOs and a policyholder going out of network still could be responsible for up to 50 percent of the costs after the deductible has been paid. This will cripple patients with HIV or Cancer who have highly expensive medications such as Truvada from Gilead. PPO plans give you flexibility where you don’t need a primary care physician and you can go to any health care professional you want without a referral—inside or outside of your network.
Blue Cross said it will automatically switch members enrolled in the broad PPO to the Blue Choice plan. Although one big difference.is that for example in Illionois the broad PPO included every hospital (209) and the Blue Choice’s network had 78 hospitals this year. Blue Choice left out some prominent Chicago-area hospitals, like Northwestern Memorial, University of Chicago Medicine, Rush University Medical Center, the Advocate Health Care system and the North Shore University HealthSystem.
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