Tag Archives: Exchange

BCBS PPO ACA

BCBS of TX PPO Members

Urgent ALL BCBS of TX PPO Members must read the following notification just released by BCBS of Texas.  This Notice affects all members who have an ACA (Affordable Care Act) PPO plan with Blue Cross Blue Shield of Texas.

As of December 31, 2015, BCBS of TX will no longer be offering their PPO insurance plans for the individual under 65 block of business going forward.  This means if you currently have one of the new ACA plans purchased after Jan 1, 2014, and it is a PPO, it will no longer be offered for 2016.   This means you must change plans for 2016!

According to BCBSTX, they have filed a new product that should give members a flexible choice.  Bottom line, their PPO network for new ACA plans is going away.  The 2016 plans are currently not available, but as soon as they are released, we will be contacting you.  You can count on us to make sure you see all options available to you, from All Insurers and that we will make this transition as smooth as possible for you.

According to BCBSTX, the reason for this is because for the past 2 years, they have been the only insurer offering individual PPO plans in all TX markets and due to anti-selection, they find the PPO product is unsustainable at an affordable price.  The will continue to offer other plan options in all 254 counties, on and off the Marketplace.

There are about 367,000 members who will have their PPO plan discontinued in 2016.  If this is you, click here.

There are about 148,000 members who are in a Grandfathered PPO plan who WILL NOT have their plan discontinued and will be able to continue to use the Blue Choice PPO network.

This does not affect Employer Group customers or Medicare members.

The Blue Advantage HMO Network will remain and BCBSTX is working to expand the number of providers in that Network.

According to BCBSTX, they paid out $400 million more in claims than it collected in premiums in 2014. Losses that high are unsustainable, and they must adjust offerings, as most of the other insurers have done also, in order to be sustainable in the new market reality.

As a Broker, who represents all the major Health Insurers, we are seeing many changes taking place in this entire market, which can have major effects on many consumers!  According to different Insurance News publications, it appears that Aetna is in the process of acquiring Humana and Anthem in the process of acquiring Cigna.  Acquisitions like this, mean less Insurers in the market, less competition, thereby creating less choices for our customers.  We realize this is not good for anyone, but we will help you find the best products that are available in the market.

Remember…A Broker works for YOU….not the Insurance Company!  It is ultimately our ONLY goal to make sure you have the plan that fits your needs best.  There are more things to take into consideration when choosing a plan, other than just the cost.  Many people found this out this year!

You will never pay more for your premium by working with a Broker, than you do by going direct with the Insurance company or by going direct to the Marketplace.

To shop for 2016 plans now, click here.

 

No Obamacare

What is Obamacare

Everyone is asking … What is Obamacare?

Most people don’t want Obamacare because their doctors will not take it.  I want to clarify something …

Obamacare is NOT an “insurance plan”. 

The term “obamacare” is referring mostly to HMO plans, and there are very few doctors taking the HMO plans (with any insurance company).   The reason why most doctors don’t want to take the HMO or Obamacare as it’s called, boils down to money.  Basically the insurance companies pay the doctors less money to treat patients who have those policies.  In addition, there can be more restrictions to the types of treatment the doctors can provide even to the extent that someone at the insurance company may determine what is “medically necessary” NOT YOUR DOCTOR.

The insurance you buy “on the exchange” at healthcare.gov is still insured by the insurance companies.   It is the same insurance that you would buy “off the exchange” either direct with the company or through an agency like us.  Same price, same benefits, same networks.  We generally tell people only buy “on the exchange” if you are applying for a subsidy or want help paying the premiums for the insurance.  Otherwise, just buy direct with the insurance companies through and agent and then your information isn’t being sent to the government.

The Obama administration made the laws that all the insurance companies have to follow.  Therefore all insurance plans have to provide certain benefits.  The doctors are kind of misleading the public by saying they won’t accept Obamacare, but I think it is more of an education issue rather than intentionally misleading.

When purchasing your insurance this year, you want to make sure to check the networks.  If your doctor is listed in the network for that insurance company then he takes the insurance.  If you need help determining which plan to choose, or which plan your doctor will accept, go to www.FreedomFreeQuote.com and get help.

If you are still confused, just stick with a PPO plan, you shouldn’t have any doctor calling it Obamacare!

COBRA Special Enrollment Period

The Department of Health and Human Services recently announced a one time Special Enrollment Period for anyone who has COBRA continuation from Group coverage. This will allow anyone currently on COBRA to enroll in a new ACA plan until July 1st. The normal rules of only being able to enroll in a Marketplace plan when first eligible due to loss of coverage, or when COBRA was exhausted(or during the Open Enrollment), are suspended for this time period. The decision was made because many people were unaware that would no longer be able to leave COBRA coverage during the year, and enroll in an Individual policy. Prior to 2014, people used to be able to purchase Individual coverage at any time during the year, so they could leave COBRA at any time. Under the Affordable Care Act, people are no longer able to purchase Individual coverage during the year, unless they have a Special Enrollment Period. Since COBRA coverage is often very expensive, it always worthwhile to compare Individual Health Insurance prices, especially if you might qualify for a subsidy. Please give us a call at 877-740-8683, to find out if you qualify for a Special Enrollment Period.

Health Insurance Deadline in Texas

We wanted to remind everyone that the last date to purchase Health Insurance for 2014 will be March 31st. After that date, the Open Enrollment will be closed for the rest of the year. A lot of people are under the impression that the deadline only applies to Marteplace, or Exchange, Plans, but the deadline will apply to all Individual Health Insurance. After March 31st, the only Plans that will be available from any carrier will be Short Term Plans. Short Term Plans do not cover pre-existing conditions, are not Guaranteed Issue, and do not qualify as Minimum Essential Coverage. So, if someone is covered by a Short Term Plan, they will still be subject to the Tax Penalty this year. If you or someone you know needs Health Insurance, please call 877-740-8683, as soon as possible, to explore your options. Even if you have a current plan, you will not be able to change to a new plan after the deadline.  So if you think you think you may want to change plans before 2015, please visit www.freedomfreequote.com , to request a personalized quote. Don’t get caught without Health Insurance, or get stuck in a plan you aren’t happy with. You may even qualify for a subsidy to help with costs. You can also visit www.healthreformenrollmentcenter.com for additional resources.

Individual Health Insurance Changing in Reform

We have recently received new information on how Individual Health Insurance policies will be changing under the Affordable Care Act. If you have a Grandfathered Policy, you will still be able to keep that plan, without making any changes. If you have purchased a policy since 3-23-2010, or have made policy changes since that time, however, your policy will be changing. Several carriers have made announcements on how they will handle the transition. Some carriers will require the policyholder to take action before the end of the year, in order to keep their policy through 2014. Other carriers will automatically transition those members, so that they can keep their current policy through 2014. While some people will receive a subsidy, and may be better off changing to a new Affordable Care Act plan on the Exchange for 2014, there are many people who will not receive a subsidy, and may have substantially higher premiums in 2014, if they don’t take an action. It is very important for you to review your options now, so that you are as prepared as possible for the coming changes. Just call 877-740-8683, or visit www.freedomfreequote.com , to request a review of your current policy.