R.I.P.: the last PPO in DFW

Monday, September 25, 2017 @ 07:09 AM
Author: Peter Young

Last week the Baylor Scott and White insurance folks held a first look session for agents to show off some of their offerings for 2018.

Most conspicuous, however, was what will NOT be offered.  The PPO plan that they offered in 2017 will be replaced by an EPO (exclusive provider organization.) Like a HMO, an EPO will only pay for services providers who are in network.  Go to an out of network provider and you will pay 100% of the bill.  The difference (vs. an HMO) is that you do not need a referral from your Primary Care doctors (PCP’s) to see a specialist.

Curiously, the BS&W HMO is what is referred to as an “open access HMO” meaning that you don’t need a referral from a PCP anyway.  Challenged on this, the BS&W staff admitted that the only difference between the two plans is the network.  People shopping BS&W for 2018 coverage should therefore check both HMO and EPO networks for their doctors!!

Both the HMO and EPO plans are Bronze plans and will only be offered Off Exchange, so they will not be available through  healthcare.gov and no Obamacare subsidy will be available.  Also, while the plans do have very high deductibles, neither one qualifies as an HSA plan.

What does this mean for people currently covered under the PPO plan? They will need to switch to a new plan for 2018.  The best time to do so will be during Open Enrollment, which be November 1st through December 15th this year.  Since this counts as loss of coverage, however, ex-PPO policyholder is allowed a Special Enrollment Period of 60 days after termination of coverage on December 31st (basically through the end of February) to buy a new plan.  Anyone taking advantage of this however, will need some sort of temporary coverage from December 31st to the effective date of their new plan!!

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