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

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

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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