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Who is Losing their PPO Health Plans?


Zulu

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This is just for those of us under 65 without Medicare who must buy individual plans. So far it appears that

  • TX BCBS PPO individual health plans are gone for 2016
  • AZ BCBS PPO individual health plans are gone for 2016
  • All NM BCBS individual health plans are gone for 2016

 

Anyone else ?

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This is just for those of us under 65 without Medicare who must buy individual plans. So far it appears that

  • TX BCBS PPO individual health plans are gone for 2016
  • AZ BCBS PPO individual health plans are gone for 2016
  • All NM BCBS individual health plans are gone for 2016

 

Anyone else ?

 

I believe this is true, but only for plans available on the exchange.

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I have not heard the info about Arizona confirmed about any company other than Blue Cross.. It is not at all clear this relates to the ACA, it probably does not as Texas did not expand medicaid under the ACA and both new mexico and Arizona did so quite late and reluctantly. Wisconsin and South Dakota also did not participate in the medicaid expansion. I don't know if the pattern will continue but it appears that states which embraced the ACA continue to offer PPOs.

 

HMO's are proving better at limiting costs as are narrow networks, That is the market working. Unfortunately it has bad, and I suspect mostly unforeseen, consequences for the full time rver under 65.

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  • 3 weeks later...

You can add IL to the list.

 

The parent company, Health Care Service Corporation, which owns TX, NM, and IL BCBSs, is getting out of the PPO market in all three states, because they lost millions on their PPO plans.

 

FL is still offering EPO/PPO plans, although the letter we received said the plans offered through the website and the marketplace will not be the same for 2016.

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  • 2 weeks later...

Because BCBS will terminate health plans in those states listed how is that related to the ACA?

I must be missing something? Last Wednesday my heart doctor told me that a lot of people are blaming

the ACA for a lot of things that have nothing to do with it!

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ACA has mandates to insurance companies as what they must do. Add taxes to some medical items. They play a major role in what insurance companies do. They must make a profit in spite of ACA. But I really have no dog in this. We use Liberty Heath Share and are very content with it.

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My understanding is part of the problem is that in states without the Medicaid expansion, the cost of care for the uninsured is still keeping costs higher overall and driving those costs back to the insurance companies without the offsetting insurance payments.

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WHJ, One can argue that the PPO plan terminations are caused by the ACA but that really tells a very small percentage of the story. As a very recently retired nurse my experience is the same as your doctor's, employers, insurance company's and politicians constantly scapegoat the ACA for all problems associated with a health care system that remains in crisis. Prior to the ACA, the US health care system cost each citizen twice as much as they would pay in any other industrialized country and our system is consistently ranked 35th to 40th in the world. In sum, we pay twice as much as any other country for a relatively poor health system.

 

Has the ACA changed this? Very little. In some respects the changes of the ACA are huge. Fifteen million more insured, preventative care covered, coverage for those under 26, coverage for those with pre-existing conditions, no life time caps, coverage for mental illness, guaranteed minimum coverage etc.. However, what is so amazingly frustrating is that even these relatively modest changes have been so severely misrepresented and demonized by entrenched interests that any hope of real change seems lost without much further crisis. In the meanwhile, as things get worse, these negative developments will be blamed on the ACA further entrenching a failed system. Despite the changes made by the ACA the US health care system continues to cost twice as much as the next industrialized country for health care ranked between 35th and 40th in the world.

 

With regard to your specific questions,some insurers are dropping PPO's due to cost. Under the ACA if an insurer offers a PPO plan they can no longer discriminate against people with pre-existing conditions or otherwise based on their claim history. They cannot mislead consumers by offering plans that do not meet minimum standards of coverage or terminate coverage when a serious condition arises. Essentially they can no longer legally commit fraud upon the public.

 

So,while one can argue the ACA caused these companies to drop these PPO plans, the real question is why can insurers in some states (my state of Michigan continues PPO plans and the average 2016 premium increase is 1.2%) continue to offer PPO coverage while states like Texas say it is too expensive when they are forced to be honest. Here the answer does not relate to the ACA but points to long term mismanagement by the state, health care system and insurance companies. Texas had the highest rates of uninsured in the country and refused medicaid expansion. If you go into a state like that and try to provide cost efficient health care you find yourself in a nightmare and certainly no ability to compete. The citizens now pay the cost of long term neglect.

 

The other issue is that insurers are finding efficiency by narrowing provider networks, specifically with HMO's. The ACA intended to push the market to find efficiencies and here the ACA is actually working. The problem of Escapees relates to an unintended consequence of the ACA that some insurance companies, in some states, cannot economically provide PPO's and Escapees travel so an HMO is not a great option. As I stated in previous posts I believe that a legislative solution can be found to this problem but legislators must be made aware of the problem. Originally, the ACA as proposed was intended to offer a national plan to compete with the private insurers. This public option would have provided a great solution for Escapees.

 

I have a hard time with folks on this board hammering the ACA, You were getting dog food and being told it was steak. Now you are really upset you can't get more dog food.

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More people may be insured but I am never sure that what I am paying for is going to cover me when I travel. Emergency care is supposed to be covered but this is what my HMO in Wisconsin told me, so I feel I need to change coverage in every state I am workamping in even if it is not my domicile.

 

To remain under the Health Insurance Marketplace plan with xxxxx Health Plan, the only requirement is that the member lives in the service area.

There is no specific minimum length of months of residency. But, Wyoming is not in our service area so therefore you would need to cancel

your policy with the Health Insurance Marketplace at 800-318-2596 and find coverage in the State of Wyoming.

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WHJ, One can argue that the PPO plan terminations are caused by the ACA but that really tells a very small percentage of the story. As a very recently retired nurse my experience is the same as your doctor's, employers, insurance company's and politicians constantly scapegoat the ACA for all problems associated with a health care system that remains in crisis. Prior to the ACA, the US health care system cost each citizen twice as much as they would pay in any other industrialized country and our system is consistently ranked 35th to 40th in the world. In sum, we pay twice as much as any other country for a relatively poor health system.

 

Has the ACA changed this? Very little. In some respects the changes of the ACA are huge. Fifteen million more insured, preventative care covered, coverage for those under 26, coverage for those with pre-existing conditions, no life time caps, coverage for mental illness, guaranteed minimum coverage etc.. However, what is so amazingly frustrating is that even these relatively modest changes have been so severely misrepresented and demonized by entrenched interests that any hope of real change seems lost without much further crisis. In the meanwhile, as things get worse, these negative developments will be blamed on the ACA further entrenching a failed system. Despite the changes made by the ACA the US health care system continues to cost twice as much as the next industrialized country for health care ranked between 35th and 40th in the world.

 

With regard to your specific questions,some insurers are dropping PPO's due to cost. Under the ACA if an insurer offers a PPO plan they can no longer discriminate against people with pre-existing conditions or otherwise based on their claim history. They cannot mislead consumers by offering plans that do not meet minimum standards of coverage or terminate coverage when a serious condition arises. Essentially they can no longer legally commit fraud upon the public.

 

So,while one can argue the ACA caused these companies to drop these PPO plans, the real question is why can insurers in some states (my state of Michigan continues PPO plans and the average 2016 premium increase is 1.2%) continue to offer PPO coverage while states like Texas say it is too expensive when they are forced to be honest. Here the answer does not relate to the ACA but points to long term mismanagement by the state, health care system and insurance companies. Texas had the highest rates of uninsured in the country and refused medicaid expansion. If you go into a state like that and try to provide cost efficient health care you find yourself in a nightmare and certainly no ability to compete. The citizens now pay the cost of long term neglect.

 

The other issue is that insurers are finding efficiency by narrowing provider networks, specifically with HMO's. The ACA intended to push the market to find efficiencies and here the ACA is actually working. The problem of Escapees relates to an unintended consequence of the ACA that some insurance companies, in some states, cannot economically provide PPO's and Escapees travel so an HMO is not a great option. As I stated in previous posts I believe that a legislative solution can be found to this problem but legislators must be made aware of the problem. Originally, the ACA as proposed was intended to offer a national plan to compete with the private insurers. This public option would have provided a great solution for Escapees.

 

I have a hard time with folks on this board hammering the ACA, You were getting dog food and being told it was steak. Now you are really upset you can't get more dog food.

 

I notice you change your tune with the latest news. At first, you posted that the reason BCBS was dropping PPO plans in Texas was because Texas didn't adopt the Medicaid expansion when offered by the Feds. You were adamant about this. I viewed this as political spin. Then, when New Mexico and Arizona also lost their PPO's, even though they did accept the Medicaid expansion, you blame it on getting into it too late.

 

Now, you're suggesting that those States mismanaged their healthcare systems. as if Michigan somehow has mastered the art. There is no comparison between the demographics of Michigan and those of Texas, New Mexico, and Arizona. So, don't presume that what works in Michigan will also work elsewhere.

 

I don't propose to know the complete solution. I didn't retire from the healthcare field, so I can't oversimplify the problem like you have. However, I do know that the problem is complex, and it involves all facets of healthcare. And, yes, that includes greed. Not only greed from insurance companies, but greed among healthcare providers who refuse to police their own industry. It also involves unwarranted and unreasonable litigation which drives up costs and mandates unnecessary and illogical medical procedures.

 

Since our healthcare system rates so lowly compared to other countries, perhaps you could point up to a model nation which you hold as ideal so that we may all see what they do correctly. Perhaps, as we learn, we can influence our decision makers to adopt some of those better methods within our own system.

 

Dog food? Steak? I don't know what that means. I do know that when I need to see a doctor, I can. When that doctor says I need a test or procedure, I get it quickly. I don't have to wait in line for weeks and months for tests, surgery, treatments, etc. Is that dog food or steak?

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Deveh, Wow, thank you for your post. You are 100% correct with everything that you posted!

The public option would have benefited many others as well. I love the dog food-steak point it is right on.

I have to shake my head when people tell me that the US has great health care, your numbers regarding the issue are

what I find when I look, thank you. I don't expect much from the people who post on this forum. Most are grumpy old men

who are not educated and many are ignorant.

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Teri, I agree there is a big problem for Escapees under age 65. I did not mean to imply otherwise. I do not think applying for new plans as you workkamp in different states is a viable solution. In addition to residing in a state you need to be able to establish domicile in that state which cannot be easily done, certainly not many times a year.

 

Chirikawa, I did not think I am changing my story. As you note, I have discussed other states before. As an example I chose Texas because that where many Escapees reside and Michigan because that is my domicile. Also, I did not say simply say state mismanagement but that it " points to long term mismanagement by the state, health care system and insurance companies." I acknowledge Texas and Michigan have different population bases but I don't think you would attempt that argument if you were familiar the implications of the recession in Detroit area.

 

I also want to make clear that I am not at all confident I will be able to continue to get PPO in Michigan in the future. As I said, part of this process is the intended consequence of the ACA forcing insurance companies and health providers to find efficiencies. This may mean that with regard to PPO's weaker states break first but others follow. I don't know. Again I suggest that rather than argue amongst ourselves we look for a solution.

 

Also, if you want to see info on better performing health systems, I have attached two articles. There are many more. If you are really interested I suggest you go to the World Health organizations web site.

 

http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

 

http://www.nejm.org/doi/full/10.1056/NEJMp0910064

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Daveh,

 

Thanks for the links. I couldn't get the first link to work. The second article was interesting, similar to what I've read before. It's difficult to compare when details of other plans are not given.

 

Most of these studies that I've read compare things like infant mortality, mortality rates for various age groups, etc. I truly believe that the U.S. is unique in many ways. We live in an inflated economy in a highly affluent manner. A large portion of our population live sedentary life styles, even many who work. Unhealthy eating habits are the norm in this country, restaurants and fast food places are packed all hours of the day. Obesity, diabetes, heart disease are at epidemic levels................yet we insist on having a healthcare system which keeps us alive in spite of our own worst habits. There is just no way this can be sustained at any efficient level. It's like trying to put a fire out while someone on the other side of the building is throwing gasoline on it.

 

Until we Americans decide that we must make changes in our own lifestyles, I think we will continue to battle the expense of healthcare which is such a burden on our society. There are some who advocate paying doctors according to their results, but how can we penalize a doctor when the patient won't follow directions?

 

Unlike some, I don't blame the ACA for all of our healthcare woes. However, the ACA was presented to us as a major step to lowering the cost of healthcare. I haven't seen that happen in the overall. Maybe a small percentage of people now have lower costs, but the cost to most individuals and to the government overall have just continued to rise. In that sense, it hasn't accomplished what it was touted for.

 

As for the public option argument, 90 million Americans are on Medicaid and another 50 million are on Medicare. Add to that, millions more who are getting their ACA coverage subsidized by the Fed. We may as well just go ahead and put everyone on a Federal system, that's where we're headed anyway.

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Chirakawa, I think that you are on the right track with a federal system. We are the only advanced country

in the world who doesn't have a single payer system. It will hold down costs because the single payer will determine

what they will pay for what service. I am sure that many of the providers will not like it including the doctors. I liked what I saw in England

but doctors were more like public health officials and that is the way that they are thought of. They are still very well paid but not to the extent as the US.

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I agree WHJ. Chirakawa I am sorry you could not get to my first link because that more directly addresses the issue than the second link. I encourage you to go to the commonwealth fund's website and look at the info comparing systems.

 

The thing that becomes apparent is that there is no country without some centralization to their health care system. Frankly there is no example in the world of a so called "free market system" that works in the health care context.

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