Blog « Independent Income Advisors

R.I.P.: the last PPO in DFW

Monday, September 25, 2017 @ 07:09 AM
Author: Peter Young

Last week the Baylor Scott and White insurance folks held a first look session for agents to show off some of their offerings for 2018.

Most conspicuous, however, was what will NOT be offered.  The PPO plan that they offered in 2017 will be replaced by an EPO (exclusive provider organization.) Like a HMO, an EPO will only pay for services providers who are in network.  Go to an out of network provider and you will pay 100% of the bill.  The difference (vs. an HMO) is that you do not need a referral from your Primary Care doctors (PCP’s) to see a specialist.

Curiously, the BS&W HMO is what is referred to as an “open access HMO” meaning that you don’t need a referral from a PCP anyway.  Challenged on this, the BS&W staff admitted that the only difference between the two plans is the network.  People shopping BS&W for 2018 coverage should therefore check both HMO and EPO networks for their doctors!!

Both the HMO and EPO plans are Bronze plans and will only be offered Off Exchange, so they will not be available through and no Obamacare subsidy will be available.  Also, while the plans do have very high deductibles, neither one qualifies as an HSA plan.

What does this mean for people currently covered under the PPO plan? They will need to switch to a new plan for 2018.  The best time to do so will be during Open Enrollment, which be November 1st through December 15th this year.  Since this counts as loss of coverage, however, ex-PPO policyholder is allowed a Special Enrollment Period of 60 days after termination of coverage on December 31st (basically through the end of February) to buy a new plan.  Anyone taking advantage of this however, will need some sort of temporary coverage from December 31st to the effective date of their new plan!!


Blue Cross: Preliminary Plans for Obamacare 2018

Friday, September 15, 2017 @ 02:09 PM
Author: Peter Young

Blue Cross held their annual dog and pony show for agents September 15 at their Richardson headquarters.   Basically this was an update on where they think they will be with the Obamacare market in 2018, but since their rates and plans had not yet been approved, there were few details.  Management would only say that rate increases were going to be less “than what you think they might be,” but added that did not mean a single digit increase.  They refused to add anything more on rates.

At least they are going to be around: Blue Cross will be the only carrier offering Obamacare in two thirds of the counties in Texas.  They are trimming their portfolio down to six plans.  This means that many current policyholders will be “mapped”,  i.e. switched, to a different plan than the one they are on now.  Affected policyholders will get a letter around the beginning of October, letting them know they will be switched, but without any detail (not even their agent’s contact information) so the letter is sure to cause confusion.  A “renewal kit”, however, will be sent out at the end of October with details of the plan they are being offered.

Policyholders who don’t like the plan they are “mapped” to, do not have to keep it – they can switch to any other policy, whether it’s with Blue Cross or not.  Also, “mapping” counts as loss of coverage, so under the Obamacare rules, they have a Special Enrollment Period (SEP) of 60 days from the date coverage under their old policy terminates (December 31st) to find something else.  This SEP is in addition to the Open Enrollment period (November 1st to December 15 this year.)

The information on the new plans did seem somewhat positive: Blue Cross has heard the complaints that deductibles are so high that people never get anything out of their insurance, so deductibles are  lower, but out of pocket limits are still high at $7300 a year.  There will be a big emphasis on where policyholders get care:  they really, really don’t want people going to the ER unless they are in danger of dying, so among other things they are expanding the availability of virtual care – access to medical advice over the phone, tablet, etc.

So the 2018 Obamacare message from Blue Cross is not entirely gloom and doom, although it is important to remember the picture is not entirely clear yet.  And of course, Congress may still step in an change all of the above