Most PPO plans no longer available for 2016

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.

Thousands of Texans are being forced to change their health care plans and some locals are concerned they won’t be able to see the specialty doctors they need. Blue Cross Blue Shield of Texas is dropping individual PPO plans and moving to HMO plans instead. NOt only are you losing your doctors but your convenience pharmacy in most cases.

Blue Cross announced on its website in early October that it will be moving its individual plans to a “preferred pharmacy network” where according to the Chicago Tribune policyholders in the area will have to fill prescriptions at Walgreens or Osco to get the lowest copays and co-insurance.The Tribune inquired about Blue Cross’ drug plans and Blue Cross removed the page from its website.

In Houston, Texas as many as 2,000 patients at M.D. Anderson also may be cut off from life saving cancer coverage with the loss of such PPO plans either through the Affordable Care Act’s federal exchange or bought privately in the individual market. Thousands of Texans are being forced to change their health care plans and some locals are concerned they won’t be able to see the specialty doctors they need.

Last week, a preview of the 61 health care plans for 2016 through the federally mandated exchange showed no PPOs plans being offered in the Houston area. For 2015, there were 19. Only HMOs or the rarer Exclusive Provider Organization, which allows members only to use doctors and hospitals within its network with no out-of-network benefits, are now listed.