The health insurance market in Texas when through some pretty big changes in 2016 and it looks like even more are headed our way for next year. The Dallas Morning News published a number of articles during August on these changes, however, we’ll have to wait until the end of September before we know all of the details.
Last year most companies quit offering individual PPO plans with the exception of Humana and Scott and White Health Plan. Most companies offering individual plans on and off the Exchanges pivoted to HMO plans, albeit, at higher rates than in 2015. The reason given for the move from PPO to HMO plans were losses incurred from greater numbers of members with health problems using the plans.
This year, those losses are being attributed to the reason for several companies who will not participate on the Exchange in 2017. Most notably Aetna and Scott and White Health Plan have announced their intention to not participate. I expect them to continue to offer individual plans off the Exchange, however, anyone signing up for such a plan will be subject to meeting underwriting guidelines. That means if you have a pre-existing condition you’ll probably need to look for a different option on the Exchange.
The flight of companies from the Exchange is leaving many Texans with only one option for health insurance. This is particularly true in our rural counties where 57 of our 254 counties will only have access to one insurer on the Exchange, usually Blue Cross and Blue Shield of Texas. The new counties affected include Parker, Palo Pinto, San Jacinto, Wharton, Colorado, and Wilson.
Rates for individual plans jumped in 2016 and are projected to continue to cost more in 2017. Blue Cross has requested a 60% increase on their individual plans which they attribute to a $770 million in losses last year. I’m doubtful they will be approved for that level of increase but do expect it to be in the 20% to 30% range. I believe all carriers will seek to raise rates on individual health insurance plans in a similar range for 2017.
There are a number of unknowns that should become clear by the end of September. These include the following:
- Will any more health insurance companies withdraw from the Texas Exchange as Aetna and Scott and White are doing?
- What will the final rates be for health plans offered on and off the Exchange?
- Will Humana continue to offer their PPO plan or will individuals be moved into HMO plans exclusively?
- What impact will the presidential election have in 2017 and beyond? A number of people believe it’s time to move forward with a public option that’s offered alongside the private offerings.
I’ll write a follow up post in October once we know everything and hope to have a friend guest post on how to review your options for the coming year. Share your thoughts, suggestions, and questions with me on my Facebook, Google +, and LinkedIn pages. I’d love to hear from you!