You may be losing your current coverage this year!
Blue Cross Blue Shield of Texas recently announced that they are terminating many of the plans they currently offer. If you are currently insured through Blue Cross / Blue Shield of Texas, you probably received the letter below. Blue Cross / Blue Shield of Texas will discontinue their PPO health insurance plans on the exchange effective 01/01/2016 and you will be forced onto a HMO. This applies only to the individual insurance marketplace.
For those that may not know what a PPO or HMO is:
What is a PPO plan?
PPO plans, or "Preferred Provider Organization" plans, are one of the most popular types of plans in the Individual and Family market. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician.
How does a PPO plan work?
As a member of a PPO plan, you'll be encouraged to use the insurance company's network of preferred doctors and you usually won't need to choose a primary care physician. No matter which healthcare provider you choose, in-network healthcare services will be covered at a higher benefit level than out-of-network services. It's important to check if you provider accepts your health plan so you receive the highest level of benefit coverage.
You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment of about $10 - $30 for certain services or be required to cover a certain percentage of the total charges for your medical bills.
What is an HMO plan?
HMO means "Health Maintenance Organization." HMO plans offer a wide range of healthcare services through a network of providers who agree to supply services to members. With an HMO you'll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan.
How does an HMO plan work?
As a member of an HMO, you'll be required to choose a primary care physician (PCP). Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you'll need to obtain a referral from your PCP.
Though there are many variations, HMO plans typically enable members to have lower out-of-pocket healthcare expenses. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. You also typically won't have to submit any of your own claims to the insurance company. However, keep in mind that you'll likely have no coverage for services rendered by out-of-network providers or for services rendered without a proper referral from your PCP.
What does this mean to you? If you are being treated by a doctor that does not belong to the HMO network, you will be required to change doctors to received benefits through your health insurance plan. Additionally, you be required to select a primary care provider (Family Practice, General Practice, OBGYN) within the HMO network and receive all medical care and directions from this provider. Even if you currently see a specialist (Cardiologist, Gastroenterologist, Dermatologist, etc) you must first receive treatment from your primary care provider and receive a referral for an In Network Specialist.
Since HMO networks are much smaller than PPO networks, most people will have to change doctors to maintain the same level of coverage.
WHAT CAN YOU DO?
Call our office at 281-448-3040. The open enrollment for individual insurance plans starts 11/01/2015 and we have options available for you and your family. We will work with you to make sure your doctor is on the plan so that you and your family receive the best value in the market. We have been working with family's for 28 years, helping them with the difficult task of finding THE Insurance Plan to meet their specific needs. Don't have time to call? Click here and send us your information. Our staff will contact you and provide you with options.