Texans, who have individual health insurance coverage through the Affordable Care Act (ACA), will have their premiums increased substantially in 2017, with fewer doctors to see. This will not affect cities like Dallas who have companies using Dallas group health insurance rates. Blue Cross Blue Shield of Texas, the only insurer that operates in all 254 counties, predicts a 57.3% increase in rates according to the consulting firm Avalere Health. In addition, Texans with individual coverage have noticed that doctors are not accepting their health insurance. This is so for many doctors in Texas are in Preferred Provider Organization (PPO) networks because they have higher pre-negotiated rates. Texans have only one carrier that participates in a PPO network, Baylor Scott and White. However, Baylor Scott and White only operates in 23 Texas counties, leaving the other 231 counties without a PPO network. As a result, plans offered by Aetna, Blue Cross Blue Shield, Cigna, Coventry and United Health Care are Exclusive Provider Organizations (EPO) networks and Health Maintenance Organizations (HMOs). These are networks many doctor don’t participate.
The expected premium increase is not limited to Blue Cross Blue Shield, but all health insurance carriers and large cities including health insurance in Fort Worth. The reason for the increase is due to financial losses by health insurance carriers. That’s to account for lower-than-hoped enrollment, sicker-than-expected customers and problems with the government’s financial backstop for insurance markets. Under the Affordable Care Act, most Americans are required to have health insurance or risk being fined. This leaves Texans with individual policies in a dilemma, paying high premiums for policies doctors don’t accept. Some Texans will receive income based subsidies through the exchanges, thereby reducing their total cost of ownership; but in many cases, these plans are also not affordable. At the same time, many consumers aren’t eligible for the income-based subsidies and get no costs reductions. That demographic includes small-business owners, self-employed people and early retirees. The expected premium increase will not affect group health insurance in Texas.
One solution to this problem is temporary health insurance for Texans. Some health carriers have short-term PPO health insurance plans. These plans have terms from 30 to 360 days. Short-term policies are not guarantee renewable, but are far less expensive even with the mandated penalty added. They may be obtained anytime throughout the year, but are not considered qualified health plans that meet the Affordable Care Act mandates. Short-Term plans are considered full coverage, but leave out some of the Ten Essential Health Benefits, which are required by the Affordable Care Act. Three excluded benefits are: maternity, mental health and pediatric dental and vision coverage. Choosing this plan over an ACA plan will trigger a fine, but will give full PPO coverage which most doctors accept at a price consumers’ can afford.
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Release ID: 117874