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For the 2016 Individual Health Market for those under age 65, it will be a very different marketplace for health insurance.  Many carriers have decided to terminate their PPO plans in Texas for individuals.  This is not the same for group health insurance sponsored by your employer.   If you have a group health insurance you should definitely keep it if it is an PPO, because when you shop in the individual market place you will not have very many options.    The only carrier with a PPO option will be Memorial Herrmann.   Be sure to check to see which carriers your doctors take.  That will be an important factor in coverage.

Here’s a review of insurance carriers and their individual product offerings in 2016:

 

Memorial Hermann- HMO and PPO offered in 2016 (the only carrier with an individual PPO in 2016), flexible format under HMO with no need to get a referral to in network specialists (but like other HMOs no out of network benefits are available unless a medical emergency), PPO plan available at considerably higher rate over HMO (rates are available).   

 

Blue Cross Blue Shield of Texas- HMO and HMO+ plans offered, both plans require selection of a primary care physician (PCP) from the plan network at enrollment and a referral to a specialist in network, HMO+ plan is a higher rate than HMO plan but DOES offer out of network benefits (similar in some ways to a PPO) but like the Memorial Hermann PPO above, out of network doctors’ charges which exceed the “insurer’s PPO adjusted rate” will be the responsibility of the patient.

 

United Health Care- HMO structure with a reduced network and PCP selection required at enrollment and referral to a specialist required.

 

Cigna- HMO structure with a reduced network and PCP selection required at enrollment and referral to a specialist required.

 

Humana- HMO structure with a reduced network and PCP selection required at enrollment and referral to a specialist required, also Houston and surrounding areas MUST apply to Humana plans through the healthcare marketplace even if not qualifying for a government subsidy.

 

Aetna- flexible format under HMO with no need to get a referral to in network specialists (but like other HMOs no out of network benefits are available unless a medical emergency), very limited network.

 

In summary please check with your doctors on which plans they take. 

Suzanne Brown Insurance Agency

A Texas Independent Insurance Agency with over 40 insurance carriers

www.SuzanneBrownAgency.com

281-558-2210

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