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2016 Outlook: No Individual PPOs Available to Health Insurance Consumers in Houston

2016 Outlook: No Individual PPOs Available to Health Insurance Consumers in Houston

But you can have an HMO

Consumers living in the country’s fourth largest city will no longer be able to purchase an individual PPO.

Market changes sparked by implantation of Obamacare are putting the squeeze on the self-employed and those who purchase health insurance outside of a large employer sponsored PPO.

The Lone Star State’s largest PPO provider, Blue Cross Blue Shield of Texas announced earlier this month that beginning in 2016, the would no longer offer individual PPO plans, though some enrolled in certain plans in 2010 might be grandfathered in.

Just yesterday, I received a notification from my health insurance provider that my plan, an HMO, would be cancelled.

Needing a break from the computer screen, I wandered out to the mailbox to find an “OPEN IMMEDIATELY, THE APOCALYPSE IS NIGH” envelope from my health insurance provider, tucked between the junk mail and a cooking magazine. Sure enough, it was a cancellation notice. Now, I too am a victim of Obamacare’s reign of insurance premium of terror.

Not to worry though. I can pay 20% more for less coverage and a deductible increase from $500 to $3250.

But my story is small potatoes compared to many families who are forced to watch in horror as their health insurance premiums triple and their deductibles multiply faster than rabbits.

The Obama administration acknowledged Monday that consumers would see health insurance premium increases across the board in 2016. They claim the average premium increases clocks in at 7.5%, though I have no idea where they’re getting these numbers. Don’t want to pay more? Then go back to the exchanges and shop around. You might pay less, but you’ll also have fewer benefits and higher deductibles.

For us self-employed Houstonians, that leaves one health insurance option — an HMO. While HMO’s are traditionally less expensive than PPOs, they also provide a smaller network of doctors — an issue particularly problematic for those with health issues that require frequenting specialists. The Houston Chronicle reported:

Last summer, Brenda Hebert got a letter from her insurer, Blue Cross and Blue Shield of Texas, that it would no longer be offering her Preferred Provider Organization plan on the federal marketplace exchange for 2016.

Although irritated, Hebert reassured herself she would simply find a PPO plan with another insurer when enrollment opens on Sunday. That way, even if she changed carriers her doctors would still be covered.

But on Monday night, as she logged onto the Health and Human Services website to get a preview of the offerings, she discovered that not one company is offering a PPO plan in the Houston market on the legally mandated exchange.

“I don’t know what I’m going to do,” she said Tuesday morning as she contemplated the scramble to find new coverage in a Health Maintenance Organization Plan, a type of insurance plan she specifically does not want and fears will limit her choices of doctors. “I don’t want to lose the doctors I have been going to for 20 years.”

But insurers counter that continuing to offer the PPOs, even though they often cost consumers more, no longer makes business sense.

…With enrollment for the 2016 Affordable Care Act marketplace just days away, the decision by insurers in the Houston area to drop all PPO offerings came as a surprise to more than just customers. Even policy experts who closely watch the implementation of the ACA were taken aback.

How many PPOs did Houston lose?

In 2015 there were 19 PPOs available in Harris County, 12 from Blue Cross Blue Shield and seven from Cigna Health Insurance, Chandler said. Now there is none. He and others say the advantage many customers find in PPOs are wider choices of doctors, especially for those with the greatest medical needs who seek specific doctors for specialty care.

In addition, in 2015 there were 17 Point of Service plans in Harris County offered by Aetna and Humana. Those type of plans also tend to offer greater choice of doctors, he said. Those, too, are gone in 2016.

And the number of platinum plans, the most expensive of the choices on the exchange, has shrunk from three to one in the Houston area.

In July, Blue Cross Blue Shield of Texas, the state’s largest insurer, sent a letter to its PPO customers noting, in part, that “the market has changed” since the Affordable Care Act was implemented.

“We found that the individual PPO plan was no longer sustainable at the cost it was being offered,” the company said. “Because we want to make sure that our plans are affordable, we decided to not offer individual PPO plans in 2016.”

Humana issued a similar explanation on Tuesday in an emailed statement to the Chronicle: “Humana chose to no longer offer preferred provider (PPO) plan options on the Marketplace in Texas for the 2016 plan year in order to retain the overall affordability and access of the individual health plans offered by Humana.”

Of course no one knows how a massive shift to HMOs will fair. But what choice do we have?

D.C. and New Mexico are in similar situations, though residents in the Beltway are still able to chose from a grand total of one PPO.

Like thousands of other Americans, I’ll be paying more for less coverage and higher deductibles. Sure I’ll health insurance, but that insurance won’t cover what I need and my out of pocket expenses will still be ridiculously high. When takes us full circle — why do I even bother keeping insurance?

I could continue to complain about the fact that even a measly ol’ HMO costs approximately 10% of my monthly income, but I understand increased premiums and fewer private options are not a glitch in the Obamacare system, they’re a function.

We’re well on our way to single-payer, exactly as designed.

Follow Kemberlee on Twitter @kemberleekaye


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nordic_prince | October 28, 2015 at 1:46 pm

We do have a choice: Widespread. Massive. Civil. Disobedience.

Do not comply with unconstitutional mandates. Dred Scott wasn’t right just because guys in black dresses said so. Likewise with Obamacrap, likewise with homosexual “marriage,” likewise with any other items on their agenda the Left tries to cram down our throat.

Take the money you’don’t waste on premiums and save it for your “shared responsibility payment” or for cash and carry doctors. Don’the surrender your freedom ~

    Ragspierre in reply to nordic_prince. | October 28, 2015 at 2:07 pm

    Rat OWN, mi Brotha…!!!

    Civil disobedience…works every time it’s tried (by enough people).



    Henry Hawkins in reply to nordic_prince. | October 28, 2015 at 2:24 pm

    “Take the money you’don’t waste on premiums and save it for your “shared responsibility payment” or for cash and carry doctors. Don’the surrender your freedom ~”

    That’s exactly what I’m doing already, and they aren’t gonna get it from my tax return either. Wink.

    nordic_prince in reply to nordic_prince. | October 28, 2015 at 3:35 pm

    “Take the money you’don’t waste on premiums and save it for your “shared responsibility payment” or for cash and carry doctors. Don’the surrender your freedom”

    Apologies for the incoherence caused by auto-completion on the tablet. Of course I meant “Take the money you’d waste on premiums and save it for your “shared responsibility payment” or for cash and carry doctors. Don’t surrender your freedom”

Henry Hawkins | October 28, 2015 at 2:32 pm

Rules For Writing Online:

Always explain what an acronym stands for so those who might not know what it means, so they don’t have to leave your website to find out. You don’t ever want to make readers leave your website.

PPO = Preffered Provider Organization (or Option)
HMO = Health Maintenance Organization

If you really want to spoil readers, make the acronym a link to an explanation.

Nitpick? Maybe. But nits pile up and soon you have a shitload of nits and who wants a shitload of nits? And any reader who finds this at all humorous may consider me a…. nitwit?

“If you like your Doctor you can – ” oh to hell with it. Everybody knows the end and it was all a lie.

Why anyone bothers to believe anything he says is beyond me. Remember when someone called him a liar out on the floor? I was kind of surprised. All politicians are liars. This guy must be so bad that he offended the professional liars. That was early on. How bad a liar must he be?

I am seeing a large number of people in the office that have had encounters with insurance companies. Since O care was passed, the insurance companies are not paying for anything, even if you have an independent policy. I can not get authorization for a stress test, period. The same goes for any number of essential diagnostic tools. So, you have insurance, your doctor, but, you still don’t have care. The interesting thing is that blacks are coming to this realization. Not to be racist, but they are the ones that put this jerk in office.

    nogden3929 in reply to david7134. | October 29, 2015 at 2:21 pm

    One Doctors essential diagnostic test is a payors fraud and abuse. I’m on the other side of the bill and the number of sleep apena test, and other BS doctors try to bill is why we have to be so strict. This fraud is most pronounced with Medicare, you can see all the commericals on TV for free scooters, knee braces, etc etc. These problems don’t happen in a vacuum, stingy payment rules are a direct result of provider billing abuse.

I’ve said it before, I’ll say it again:




This was planned from the very beginning. Obamacare was not INTENDED to work. It was intended to FAIL, and cripple the private industry so badly that single payer would be the only solution.

Mark my words. The next Democrat President, whether its 2016, 2020, or 2024, will suddenly have the media manufacture another ‘crisis’ in healthcare, just like they did in 2009/2010, and they’ll bloviate about how WE TRIED BUT IT DIDN’T WORK, NOW WE HAVE TO HAVE SINGLE PAYER.

And what is even worse is that Republican leadership is so stupid and short-sighted that they will be surprised by it.

    rinardman in reply to Olinser. | October 28, 2015 at 8:01 pm

    And what is even worse is that Republican leadership is so stupid and short-sighted that they will be surprised by it.

    And what is even worse than that, is that after being surprised….they’ll go along with it!

Henry Hawkins | October 28, 2015 at 7:05 pm

Meanwhile, back in North Carolina…..

“The company [BC/BS of NC] has asked the North Carolina Department of Insurance to approve a 35 percent average increase in premiums for its exchange plans for 2016. The underlying numbers are stark. In 2014, Blue Cross spent $1.65 billion reimbursing medical expenses for its exchange customers. But it took in just $1.18 billion in premiums, plus $343 million in federal subsidy. That’s a $123 million loss. All indications are that the company is running a substantial deficit in 2015, as well.

North Carolina’s experience is hardly unique. Health insurers across the country are also experiencing massive losses despite healthy inflows of federal cash. The scope of the problem varies by state. But the problem is essentially national. It stems from the very architecture of the ACA, which offers too heavy a subsidy for some customers and then attempts to spread that cost over too narrow a set of other ones.”

Carolina Journal Online:

    rinardman in reply to Henry Hawkins. | October 28, 2015 at 8:10 pm

    Health insurers across the country are also experiencing massive losses despite healthy inflows of federal cash.

    That’s easy to fix. Just give them more federal cash!

    Then raise taxes, to pay for it. And then give it a catchy name…like “redistribution of wealth”.

This is what Democrats have been working towards for 42 years, history shows this is what they had in mind, just took them longer than they would have liked to get here;

Ted Kennedy….

Just five years after the HMO Act of 1973 was signed into law, the U.S. Senate Committee on Human Resources, Subcommittee on Health and Scientific Research, held a hearing to discuss amending the Act. Following are excerpts from Senator Ted Kennedy’s opening statement at the March 3, 1978 hearing:

“Today the Subcommittee on Health and Scientific Research holds hearings on proposed amendments to federal statutes supporting the development of health maintenance organizations…These amendments would extend and strengthen current authorities supporting HMOs in this country….

“As the author of the first HMO bill ever to pass the Senate, I find this spreading support for HMOs truly gratifying. Just a few years ago, proponents of health maintenance organizations faced bitter opposition from organized medicine. And just a few years ago, congressional advocates of HMOs faced an administration which was long on HMO rhetoric, but very short on action.

“The current revival of the HMO movement should come as no surprise. HMOs have proven themselves again and again to be effective and efficient mechanisms for delivering health care of the highest quality. HMOs cut hospital utilization by an average of 20 to 25 percent compared to the fee-for-service sector. They cut the total cost of health care by anywhere from 10 to 30 percent. And they accomplish these savings without compromising the quality of care they provide their members.

“In fact, many medical experts argue that the peer review built into group practice in the HMO setting promotes a quality of care superior to that found in the traditional health care system…. “In our enthusiasm to see HMOs proliferate throughout this country we should not lose sight of the need to guarantee the quality and integrity of the prepaid plans we create.”1