BCBS of Texas to drop individual PPO plans in 2016

[ML]

For Fulltimers that domicile in Texas and pay for your own health insurance this article may be of interest.


About 367,000 Texans will lose their individual health insurance policies next year when BlueCross BlueShield of Texas stops offering its Blue Choice PPO (preferred provider organization) plans.
The Richardson-based insurer started notifying customers and agents of the change this week, noting that it paid out $400 million more in claims last year than it collected in premiums.


The complete article is here: BlueCross BlueShield of Texas to drop individual PPO plans in 2016

[GMandJM]

ML wrote:
I believe these theories provide an opportunity for new businesses.

This part of your reply really is genius.

My friend in Austin and his artists' co-op is/are considering incorporating and becoming a small business. BCBS-TX could end up insuring the same people they're dropping.

Also, one of the "headhunter" companies we deal with locally is changing its business model from using Independent Contractors to hiring the same people as employees. I wonder if they'll fall under the Employer Mandate and have to offer health insurance.

Interesting stuff going on in the insurance industry.

[GMandJM]

Thank you for (Emily) Post-ing. 🙂

[TechWriter]

Thread Hijacking = occurs when one or more individuals commenting on the original posting, go off topic, creating a separate conversation. This is rude, and bad internet etiquette. If people want to discuss a different topic, they should start their own thread.

[Skid_Row_Joe]

GMandJM wrote:
Individual Plan Subscribers = People who pay for their health insurance out-of-pocket and do not have insurance through an employer.

Group Plan Subsribers = People who have employer-based health insurance.

Affordable Care = Affordable Care Act

ObamaCare = A term often used to refer to ACA. Uesd somewhat interchangably depending on how you feel about ACA. I used both terms together to be neutral.

Pool = Group or subset of persons (in these instances: Those having or needing health insurance coverage)

Offloading = Directing into lower benefit plans such as an HMO and/or other insurance providers in the ACA marketplace (some people took exception to the term "offloading", so perhaps "shedding" more palatable)

I realize that I'm a bit of word-wonk when it comes to this subject. Hopefully this will clear things up for you, SRJ.

When people don't take the time to understand things it leads to that "lemming march" Bob Nestor described.

You still miss(ed) the mark GMJM.

The Q was to differentiate between the two plans, then define their differences.

The way your 1st post reads, there's no way to understand what you're referring to, since Individual Plans are available both directly, and, indirectly through the ACA sponsored site.

There also are misinterpretations of the individual plans that both websites offer, as not being identified in the post(s).

PPO and HMO are both available on both entities, at differing costs out of pocket per the individual - as well as different deductibles governing such plans potential costs.

And for the record, there's no such thing as; "Obamacare." That shouldn't be a part of the nomenclature here, as there then becomes confusion over plans, laws, etc.

Whether the PPO plan is being dropped has not been identified going forward as a loss that cannot be recouped as more and more individual workers join the required by law, mandatory healthcare insurance plans offered directly and by the ACA websites.

As the fines increase on the delinquent individuals failing to procure said health insurance coverages, their penalties will increase exponentially, as enforced by the I.R.S.

In short, the ACA is in a state of flux, as per the insurance carriers making a profit or a loss over time. Which is the bottom-line here.

[GMandJM]

A little OT here, but Tiny Houses are such a fun idea! We linked to a story about them awhile back.

There's an entire TV show about them? How cool! Thanks for the link.

(btw, there should be a law against trying to teach Keynes theory of business cycles at 8am 😉 ).

[ML]

Though a necessity... economics wasn't my most favorite class in school. Supply and demand was about all I took away from it.

As they say if we don't study history we are doomed to repeat it.

For economic trend/historytrend/history lovers.

I believe these theories provide an opportunity for new businesses.

Downsizing ie Tiny Housesand fulltime rving come to mind.

[GMandJM]

ML wrote:

Returning to the gold standard?

Mike Moffat is on Twitter? I didn't know that. Thanks!

He makes economic theories easily understandable for everyone.

The click-through that explains "flat money" is a good example.

(Disclaimer: I don't always agree with what MPM says. 😉 )

[GMandJM]

Individual Plan Subscribers = People who pay for their health insurance out-of-pocket and do not have insurance through an employer.

Group Plan Subsribers = People who have employer-based health insurance.

Affordable Care = Affordable Care Act

ObamaCare = A term often used to refer to ACA. Uesd somewhat interchangably depending on how you feel about ACA. I used both terms together to be neutral.

Pool = Group or subset of persons (in these instances: Those having or needing health insurance coverage)

Offloading = Directing into lower benefit plans such as an HMO and/or other insurance providers in the ACA marketplace (some people took exception to the term "offloading", so perhaps "shedding" more palatable)

I realize that I'm a bit of word-wonk when it comes to this subject. Hopefully this will clear things up for you, SRJ.

When people don't take the time to understand things it leads to that "lemming march" Bob Nestor described.

[ML]

GMandJM wrote:
I've read the same thing about people using ERs because they can't legally be turned away. I wonder if the new requirement that everyone must have insurance or pay a fine will change that.

Half price for cash sounds like a win-win-win:
You pay less (presumably)
Your insurance pays nothing
Your doctor gets paid without having to hassle with the insurance co and wait for payment

The only downside I can think of is that it's not applied to your yearly deductible that way.

There was an opthalmologist's (sp) office in our javascript:;area that had a sign saying they accepted payment in gold. Never tried it though. Seemed odd to me.

Returning to the gold standard?

[lbrjet]

We had a BCBS PPO in Indiana for years prior to ACA. No PPO option at all in 2014. I guess they started the trend. We moved to AZ at the beginning of 2014 and obtained an excellent PPO plan there. Hopefully it will stick around for awhile. My guess with TX is they priced the plans too low in the beginning and can't get rate increases high enough to cover their mistake. Our AZ plan is 975 a month for 2 people in their 50's, not sure what the price in TX would be.

[Skid_Row_Joe]

westernrvparkowner wrote:
The fact they are stopping PPOs for individuals and not employer groups would indicate that BCBS got severe "adverse selection" in their enrollment. Many people predicted this. To me, it was obvious the most likely people to buy insurance under the ACA were those people who had pre-existing conditions, were older, those who could only afford a policy with the financial supplements (and you can easily document that poverty is linked to poorer health) and those people who already were paying for a policy and had to make the jump to an ACA approved policy.
The entire financial structure of the ACA was to force younger, healthier, and hence profitable, people into the system to offset the costs of those other people. This obviously has not happened. Employer group policies do not have this adverse selection. Businesses tend to hire younger, healthy people.
And finally, I would guess that BCBS of Texas has determined that out of Texas claims cost them more than claims from in state. Somewhat logical, since there is more paperwork, and less local control. Logic again would suggest that employees based in Texas are more likely to seek treatment in Texas than members of Escapees.
Now for my political comment: If the government tells you they are going to help you, it is most likely they mean they are going to help you empty your wallet.

Whoa! :E

I'm glad that you stated that your post was "just a guess," because it's packed with misinformation as well.

Your claim of; "severe" "adverse selection" above, needs some factual links to back-up your allegation(s) as just one example of your non-fact based claims.......

I am based out-of-Texas for nearly 40 years straight.

I subscribe to, and am a member of BCBSTX for at least a couple of decades+, and much of what you wrote is not only preposterous, but just plain wrong (as in incorrect.....) wrver.

I'd suggest you do some homework on the FACTUAL specifics of BCBSTX healthcare and insurance, and get back to us with your newly found, factual information regards BCBSTX going forward in Texas.

[Skid_Row_Joe]

GMandJM wrote:
Looks like BCBS-TX wants to move all the individual plan subscribers to HMOs or offload them into the Affordable Care/Obamacare pool. Good grief.

Bad news for independent contractors. I hope that doesn't turn into a national trend.

The last bit says it will still cover anyone whose plan predates 2010.

Thanks for the info.

:h Huh?

Please clarify, define and differentiate between; "individual plan subscribers," and, "the Affordable Care/Obamacare pool???"

BTW.....and FYI...there is no such plan as; "the Affordable Care/Obamacare pool."

Your post doesn't begin to make sense. Is why I ask?

[GMandJM]

I'm not sure I can agree with everything you're saying, westernrvparkowner, but it does give us something to think about.

Yes, the overly-optimistic scenario of the ACA mandate was that it would push younger, healthier people into the insurance "pool". It seems, as many suspected, they chose less expensive HMO's. No shocker.

Totally agree with you there. But I'm seeing something else:

Health insurance companies use statistics to figure out which insureds are cost-effective and which aren't and they can cut up the "pools" any way they want. In this instance they've divided it between employed/employer-based PPO insureds vs self-employed/not-employed PPO insureds.

What would their cost analysis have been had they considered ALL PPO insureds as one pool? Or self-employed vs. non-employed? (We'll never know.)

And it makes me wonder who might be next? Cut the pool smaller and say "We're not going to offer PPOs to businesses with less than 10 employees"? 50 employees?

I realize that an BCBS-TX is a for-profit entity and not a charity....I just don't like the trend they're setting. A very valuable insurance option for self-employed/not-employed people is gone and that's upsetting (to me, anyway).

(And I won't even mention that someone, somewhere PROMISED we'd be able to keep whatever insurance coverage we already have.)

And as for the wallet thing, I might agree with you except if I did DianneOK would yell at us for talking politics. So let's don't go there. 😉

[bob_nestor]

Seems one of the biggest problems is the legal requirement for insurance companies to spread their cost increases on any one plan over all other plans they offer. Because of that they may choose to eliminate a high cost plan in an effort to hold down prices to subscribers on other plans they offer. I think I read that this was exactly the reasoning Blue Cross gave for their decision.

We can argue the pros and cons of ACA, single payer systems, greed on the part of Doctors, hospitals, insurance companies or whatever, but in the end it probably doesn't matter as prices will go up ahead of costs, or services will decline to match what can be charged. We need a critical mass of people and politicians to develop a real understanding the the relationship of cost-to-price and recognize that shifting costs doesn't diminish them in any way. It may lower prices to one privileged group but it will increase prices to others to compensate.

No doubt the BCBS of Texas decision will prompt a lot of full timers to relocate to other States which currently offer better insurance plans at lower prices, but these changes will come to those States in time as well. We are like lemmings marching to the edge of the cliff - some of use see the edge and object to the path we're on, other's see it as a great mass migration journey and drag us along with them.