BCBS Texas to stop offering PPO Plans in 2016

[KHenson]

Unfortunately group health insurance is not an option. Group health insurance has to involve an employer-employee relationship. Unless we all become employed by Escapees no such relationship exists. Additionally, the high costs, lack of choice, lack of premium tax credits, and complications of group health insurance are enough to make it an unattractive option even if it were available.

 

Some people point out the fact that AARP offers group health insurance to its members where there is no employee-employer relationship. That is no longer offered**. Besides, their offering was never a true major medical group plan. With ACA mandating Minimum Essential Coverage this option is gone as well. I suspect this is what was proposed before within Escapees as mentioned by Kirk.

 

The traditional group health option is a bit archaic now and many employers are moving towards defined contribution health plans whereby the employer pays the employee to go find his own individual health insurance.

 

**referring here to their under 65 option they used to have. Their Medicare supplement plans are still available of course

 

Kyle,

 

While the exchange will provide a valuable resource to inform folks of their options, it will not change what is available on the market. What is the possibility/feasability of creating a group plan for say Escapees/FMCA/etc, members?

[Zulu]

Some disturbing health care changes . . .

• Exchange plans becoming more inferior to plans offered outside of the exchange - you're free to buy that non-Exchange plan, but you'll forfeit the gov't subsidy

• Health care mergers - 5 becomes 3

[trostberg]

The HMO issue is a problem if you are far away from your state where your health insurance is issued.

 

The Marketplace was very helpful to get me enrolled in WY Blue Cross while I am working in Yellowstone. My HMO in my legal residence of WI would not allow me to keep my WI insurance since I was out of their service area. Even double checked with a supervisor if I could get insurance outside my legal resident state. My mailing address is General Delivery and they accepted my application with that address. The insurance company will defer to whatever the marketplace says.

 

Since WY is closer to where I plan to spend my time in the North and West it works out better.

 

So if your legal residence state is not where you are spending your time and you don't have a national provider network option, you might want to give them a call. Moving is a qualifying event. I was really, really surprised how helpful they were.

[accumack]

I agree the problem is HMO's as we are not in Texas very often. The current plan allows us to go anywhere we are currently in California and I'm seeing a doctor out here for a knee problem and it is covered the same as if I were in Texas. With an HMO I'm paying or I have to go back to Texas for an appointment. I hope something happens so that is not the case or we may forgo coverage why pay for coverage that we have to pay out of pocket anyway.

 

The HMO issue is a problem if you are far away from your state where your health insurance is issued.

 

The Marketplace was very helpful to get me enrolled in WY Blue Cross while I am working in Yellowstone. My HMO in my legal residence of WI would not allow me to keep my WI insurance since I was out of their service area. Even double checked with a supervisor if I could get insurance outside my legal resident state. My mailing address is General Delivery and they accepted my application with that address. The insurance company will defer to whatever the marketplace says.

 

Since WY is closer to where I plan to spend my time in the North and West it works out better.

 

So if your legal residence state is not where you are spending your time and you don't have a national provider network option, you might want to give them a call. Moving is a qualifying event. I was really, really surprised how helpful they were.

[docj]

JM Atena bought Humana and Athan(sp) bought Cigna. Athan owns BCBS plans in I think 14 states.

c u on the road

 

These mergers were both just announced and I'm sure neither one has taken place yet. The companies will probably have to get anti-trust approvals from the Justice Department before they can go forward.

[KHenson]

Teri,

 

Although I am glad this scenario has seemingly worked out for you I would advise against others following this path. Here is why...you are enrolling in a plan and receiving a subsidy based on WY demographics/residency yet you presumably file taxes in WI where your legal residence is. While it may be true that the insurance company defers to the Marketplace qualifications, if the WY insurance company deems you unqualified based on the fact that you are not/were not a resident of the state where you purchased your plan then they could actually cancel your coverage and/or your subsidy based on the grounds that you were never eligible. Just a friendly caution.

 

Another thing to keep in mind when contacting the Marketplace is that you are speaking to a 3rd party company contracted to handle enrollments. It is not uncommon to make back to back calls to the Marketplace, ask the same question, and get 2-3 completely different answers.

 

Again, I am not telling you what to do here--I am just pointing out a couple of problems with this approach.

 

The Marketplace was very helpful to get me enrolled in WY Blue Cross while I am working in Yellowstone. My HMO in my legal residence of WI would not allow me to keep my WI insurance since I was out of their service area.

[trostberg]

I was told by my Wisconsin insurance I was subject to cancellation by living in Wyoming. All my options in my county are HMOs.

So what do you do?

 

Thank you

Teri

 

Teri,

 

Although I am glad this scenario has seemingly worked out for you I would advise against others following this path. Here is why...you are enrolling in a plan and receiving a subsidy based on WY demographics/residency yet you presumably file taxes in WI where your legal residence is. While it may be true that the insurance company defers to the Marketplace qualifications, if the WY insurance company deems you unqualified based on the fact that you are not/were not a resident of the state where you purchased your plan then they could actually cancel your coverage and/or your subsidy based on the grounds that you were never eligible. Just a friendly caution.

 

Another thing to keep in mind when contacting the Marketplace is that you are speaking to a 3rd party company contracted to handle enrollments. It is not uncommon to make back to back calls to the Marketplace, ask the same question, and get 2-3 completely different answers.

 

Again, I am not telling you what to do here--I am just pointing out a couple of problems with this approach.

[KHenson]

I appreciate your difficult position Teri. All of us RVers are in the same boat (or should I say RV?)

 

If there aren't any PPO options or options with extended networks in your state of domicile then you either have to tolerate an HMO or permanently change states. No easy solution I know. Health insurance just isn't designed with full-time RVers in mind. Hopefully some things will change over the coming months and years whereby we can purchase across state lines (and insurers are willing to sell across state lines).

 

It certainly does not help when the Marketplace gives you information that conflicts with what the insurance company or your broker tells you either.

 

I was told by my Wisconsin insurance I was subject to cancellation by living in Wyoming. All my options in my county are HMOs.

So what do you do?

 

Thank you

Teri

 

[Ronbo]

Christian healthcare ministries. I pay $150 per month for the wife. They cover everything after the first $500. We added brothers keeper for very little and her care has no cap. If you decide to sign up message me so I can give you her name. She gets a free month.

[airstream harry]

Kyle,Does the government give the insurance companies a subsidy for Advantage plans. Back in my working days they did subsides HMO plans.

c u on the road

[KHenson]

Yes, Harry. The Medicare Advantage (Part C) program as well as Part D are both subsidized by the government. They use a rather complicated formula to determine the amounts they pay, which varies geographically, but for Part C it's around $800 +/- per month per member that the government pays to the insurance company. That's why Medicare Advantage plans can have very low premiums.

 

Just to be clear though, the previous conversation about HMOs in this thread are not referring to Medicare Advantage plans.

 

Kyle,Does the government give the insurance companies a subsidy for Advantage plans. Back in my working days they did subsides HMO plans.

c u on the road

[pjstough]

... Hopefully some things will change over the coming months and years whereby we can purchase across state lines (and insurers are willing to sell across state lines)...

 

 

 

Wont this require a change is the US Constitution?

[KHenson]

Paul,

 

No. Health insurance is not a addressed in our Constitution. There would be nothing to change there.

 

Insurance companies are, however, protected from interstate competition by the McCarran-Ferguson Act (1945), which grants states the right to regulate health plans within their borders.

 

A few states have actually signed into law (Kentucky, Georgia, Maine) and Wyoming has enacted a law allowing interstate sales of health insurance. But this all happened around a lot of uncertainty with the ACA and so far insurers are reluctant to venture across state lines.

 

Wont this require a change is the US Constitution?

[Velos]

Christian healthcare ministries. I pay $150 per month for the wife. They cover everything after the first $500. We added brothers keeper for very little and her care has no cap. If you decide to sign up message me so I can give you her name. She gets a free month.

 

http://www.chministries.org/howitworks.aspx

Christian Healthcare Ministries (CHM) is a nonprofit health cost sharing ministry through which Christians voluntarily share each other’s medical bills. It is not an insurance company. CHM is based on Galatians 6:2 (“Carry each other’s burdens and so fulfill the law of Christ”) and on the actions of the New Testament church found in Acts 2 and 4. More about CHM

 

Brothers Keeper: http://www.chministries.org/catastrophicbills.aspx

[Dranoel]

Brother's keeper (CHM) looks like an ad.

[Ronbo]

Brothers keeper is an ad on. This meets the requirement of aca

[trostberg]

I am just glad I did not change my legal residence to Texas if I will be facing the same situation as I am in WI with HMOs. My priority this year was to get health coverage closer to the west coast where I plan to spend most of my time. I have no reason to spend much time in TX or FL and SD is no good for health insurance.

 

Will be in WY now exploring what I can get for residency since I may be living and working here with the National Park multiple seasons. Physical address living here could be an issue .....we will see. It seems like I would have legality on my side since I am not trying to escape taxes (I am paying WI and ND tax where I have income) and I am actually living and working here. The marketplace made a comment that since I am living and working in a federal agency they needed to find a solution and so far Wyoming Blue Cross has had no issues. I am not hiding anything about my state connections.

 

Thanks for what you can continue to do for RVers.

Teri

 

I appreciate your difficult position Teri. All of us RVers are in the same boat (or should I say RV?)

 

If there aren't any PPO options or options with extended networks in your state of domicile then you either have to tolerate an HMO or permanently change states. No easy solution I know. Health insurance just isn't designed with full-time RVers in mind. Hopefully some things will change over the coming months and years whereby we can purchase across state lines (and insurers are willing to sell across state lines).

 

It certainly does not help when the Marketplace gives you information that conflicts with what the insurance company or your broker tells you either.

 

[TCW]

...I may be living and working here with the National Park multiple seasons...

It may not be a cost effective alternative, but I believe that seasonal employees can participate in the FEHB (Federal Employees Health Benefit Program), but they do not get the government cost sharing and the plans are pretty pricey but also pretty comprehensive coverage.

[trostberg]

I don't have enough hours to qualify for employer coverage with either of my employers in WI or WY. I am a concessionaire employee in WY and work via computer in WI..

I had a great high deductible plan that had national coverage that was reasonable without a subsidy but not allowed for anyone over 30 now and it was discontinued.

 

I was told even if I had enough hours the coverage is over 3 times more expensive than the marketplace

[Jack Mayer]

I don't have enough hours to qualify for employer coverage with either of my employers in WI or WY. I am a concessionaire employee in WY and work via computer in WI..

I had a great high deductible plan that had national coverage that was reasonable without a subsidy but not allowed for anyone over 30 now and it was discontinued.

 

I was told even if I had enough hours the coverage is over 3 times more expensive than the marketplace

Yeah, you are pretty much screwed. So am I, unless I get grandfathered into my BCBS TX plan. I "should be", but until it happens I'm not counting on anything. What I'll likely do if I'm not grandfathered in - and nothing else is available - is to go on an HMO for the partial year until Medicare kicks in. In this case I'm "lucky" to be "old".

 

I'm not sure what the answer is in the long run. Other than a nationwide single payer system. I'm not really opposed to that....but for sure the gov. will screw it up if the Congress is involved in it. (I guess that is an editorial comment).

[airstream harry]

I agree Jack. A single payer looks like the answer. The government will screw it up but maybe it can be as good as or better than Medicare.

c u on the road

[Kirk W]

 

I'm not sure what the answer is in the long run. Other than a nationwide single payer system. I'm not really opposed to that....but for sure the gov. will screw it up if the Congress is involved in it. (I guess that is an editorial comment).

A Canadian RVing friend used to tell me, "If you think that your health care is expensive now, just wait to see what happens if the government ever makes it free!"

[D&J]

This is not good news for us and I suspect it will affect many other full-time Escapees not yet on Medicare.

 

I think that the policies they are discontinuing are the individual PPO policies that where grandfathered in when ACA started and they had so many problems. ACA does not allow any individual plans and all plans have to conform to the ACA guide lines, it doesn't make any difference if they are purchased through the exchange or not. When this all started we had individual PPO plans through BCBS of Nebraska and our plans were cancelled because they didn't conform to the ACA, We ended up with a family BCBS PPO plan for the two of us with coverage we didn't want or need but that's what happens when you are forced into a group plan. Now that I started on medicare I was taken off our family plan but it's still not considered a individual plan for my wife it's still a family PPO plan. If you are looking for coverage the Heathcare.gov site is a good place to look for plans in your area.

 

When this first started many on this site wouldn't listen to us that were being railroaded into this government healthcare expensive mess but now the rest of the story is coming to light namely we can't afford it.

 

Denny

[bigboomer]

Denny,

 

You hit the nail on the head....the whole idea for the ACA was to make sure no one was discrimated against getting healthcare whether you had a pre-existing condition or you were unable to "afford" it....but why is it the law allows insurance companies to discriminate and not sell you a policy if you do not have a "physical" address such as us FT rvers?

 

The whole ACA system was designed to fail so eventually a single payer system such as Canada or any of the European socialist governments is put into place.

 

A friend of mine from Ireland said they use to pay 9% of their wages into the system for healthcare. This gets you a card so you can go to the doctor or hospital. The catch is that if you need serious treatment such as heart surgery, etc. and you fall into the end of the funding cycle and the government has not increased funding for those surgeries you have to wait for the next cycle before you can have the procedure done.

 

Now do you think based on how you see what goes on in DC with Congress arguing over general funding this is going to work?

 

Bring back the basic BCBS 80/20 plans for everyone with no free rides....you pay your share up to 20 percent, period!

[D&J]

Denny,

You hit the nail on the head....the whole idea for the ACA was to make sure no one was discrimated against getting healthcare whether you had a pre-existing condition or you were unable to "afford" it....but why is it the law allows insurance companies to discriminate and not sell you a policy if you do not have a "physical" address such as us FT rvers?

The whole ACA system was designed to fail so eventually a single payer system such as Canada or any of the European socialist governments is put into place.

From when this started we only had a few companies to pick from because our home base is in a small rural town, now the last I looked we were down to two because the others went broke. We had to stay with the overpriced BCBS option because of national coverage, we are glad we decided to keep our house for a home base just because of health care.

 

Denny