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What to Expect for Open Enrollment for 2016 Plans

Jul. 23, 2015

We're getting ready for Open Enrollment for 2016. Blue Cross and Blue Shield of Texas (BCBSTX) will offer individual coverage options in every market in the state, both on and off the exchange. If you have an individual health plan or are looking to buy one in 2016, here are some of the changes you need to know.

When is Open Enrollment?

Open Enrollment for individuals runs from November 1, 2015 through January 31, 2016. If you are looking to buy your own health insurance plan for 2016, you can do so during this time.

If you already have health insurance, this is also the time you can:

  • Look at other plan choices
  • Compare plans and prices
  • See if you can get financial help

You'll be able to see what plans will be available starting in October, when the "window shopping" period begins. This will give you time to weigh your options, ask questions and decide what will work best for you – before it's time to sign up.

What will be different for individual plans in 2016?

There are some changes in the plans we intend to offer in the individual market in 2016. We won't be offering PPO insurance plans in the individual, retail market. However, we intend to continue to offer HMO plans. This change does not affect our employer group customers or the grandfathered PPO individual plan members.

Why is Blue Choice PPO going away?

BCBSTX was the only insurer to offer an individual PPO insurance plan across the state to individuals in 2014 and 2015. Since the Affordable Care Act began, the market has changed. We found that the individual PPO plan was no longer sustainable at the cost it was being offered. Because we want to make sure that our plans are affordable, we decided to not offer individual PPO plans in 2016.

Why couldn't you just keep offering the individual PPO plans and raise the rate for them?

The law requires that we set our individual plan rates based on all of our individual members' claims history. This means that if the costs of one plan are high, it will raise the rates of all other plans, not just the high-cost plan. If we kept the Blue Choice PPO, this would have raised the rates so much for all our other plans that most people wouldn't be able to afford them. By dropping the PPO, we can still offer our other plans at reasonable rates.

I have a PPO plan. What will this mean for me?

If you have an employer group PPO plan, this will not affect you. If you enrolled in the individual Blue Choice PPO plan last year, you won't be able to keep your PPO plan in 2016. We're sharing this information well in advance of the required notification date so that you have plenty of time to research the plan options that best suit your needs. We will work with you and your doctors to lessen the impact of this change to your ongoing care.

My Blue Choice PPO plan is "grandfathered." Is it being discontinued too?

No. If you have a grandfathered individual PPO plan, it will still be available in 2016. Grandfathered individual plans are plans that existed on March 23, 2010, when the Affordable Care Act became law. If you don't know if your plan is grandfathered, check your plan details or call the customer service number on the back of your BCBSTX member ID card.

Will I be able to keep my doctor and/or hospital if I switch plans?

Currently, we have two provider networks for our individual plans: Blue Choice PPO and Blue Advantage HMO. Some providers are only in the Blue Choice network, and some of them have decided not to join the Blue Advantage HMO network in 2016. So, with the Blue Choice PPO individual plans going away, these providers will no longer be an in-network option for most of our individual members. If you have a grandfathered plan, you will still have access to the Blue Choice network.

If your doctor is not in the Blue Advantage network, we will work with you and your doctor to lessen the impact of this change to your ongoing care.

When can I see 2016 plan details and rates?

Individual plan details and rates will be available in October 2015. Open Enrollment begins November 1, 2015.

Have questions now? We encourage you to talk with your insurance agent or call the customer service number on the back of your BCBSTX member ID card.


View 2015 news