2016 Healthcare Information for Individuals and Families
If you have started looking around at health insurance in the past few days, you are finding out that there have been drastic changes in health insurance policies and how they perform. Especially in Texas, and, more especially, here in the Houston market. Here is a summary of some of the changes --
PPOs are not offered in the Houston Market from any major carriers. One exception is Memorial Hermann Health Plans. See below for more information.
PPOs offer out of network benefits. HMOs do not. VERY important if you are using a doctor you like, but he isn’t in the network of your current plan. If you end up on an HMO, you won’t be able to use him/her on the plan at all.
Benefit amounts, limited number of copay office visits, higher deductibles/out-of-pocket expenses are all being affected
There are better rates out there if you shop around, but you will have to change plans, and probably give up or change coverages, deductibles (higher) copays and providers.
It seems that the insurance carriers lost a lot of money in their PPO plans in 2014 and 2015. Click here to see one media report. They are re-calibrating their offerings to be more financially stable. You might think they make plenty of money, LOL, but the reality is that they are significantly changing what they offer for plan year 2016 due to cost pressures.
In other words, it seems, the regulations they are forced to comply with, are causing higher costs, which they did not anticipate. And, they don’t think you will pay what they would have to charge for those plans.
EPOs and HMOs are the only types of plans being offered right now. EPO is Exclusive Provider Organization. No referral is required to seek specialist treatment. That is because the only providers available are ones that are already a part of their network, so you have to go to their doctors. (in other words, if your doctor is not on their plan, you will have to change doctors.) HMO is Health Maintenance Organization. This is the old, original scheme that was used when health insurance first came out in the 1970s, thanks to a bill sponsored by Sen Ted Kennedy. It has been updated several times since then, but it is not the same animal we are used to in PPOs.
HMOs are designed to cut costs, and provide maintenance care, generally in your home market area. If you are out of their service area (IE out of state) access to covered care can be limited or unavailable. They cut costs by contracting with a specific group of hospitals, facilities and doctors and providers. They are certainly worthwhile, but if you are used to PPOs and how they work, you will have to re-educate yourself for this new product.
As noted above, Memorial Hermann Healthcare System opened a health insurance company a few years ago. They offer individual plans. PPOs and HMOs. Since they only operate facilities and provider groups in the Houston area, they are only available to those who live in the Houston Metro area. Therefore, the service area may be smaller than other carriers, and their network only includes Memorial Hermann providers. BUT, they do have a PPO, which includes out of network benefits. Please let us know if you would like more information or a quote.
News reports and other information has indicated that you can find cheaper premiums if you just shop around this year. That is probably generally true, BUT, it means disruption for you in changing plans, possibly changing doctors and facilities, and just general aggravation and turmoil. Especially if you are currently in treatment/care for an ongoing medical condition.
SOOOO, please pay attention to the details of the new plans that are available for 2016.
And remember, open enrollment is from November 1 2015 to January 31 2016. To get a plan that starts January 1 2016, your application MUST be submitted by December 15 2015.
More information is available at healthcare.gov
Today is Hump Day, but its also the day before
Turkey Day, so many of us are about done for the week.
