Blue Cross Blue Shield of Texas® discontinues Blue Choice PPO for 2016

by Angela

Blue Cross Blue Shield of Texas® (BCBSTX) recently announced that one of the most popular health insurance plans available will no longer be offered in 2016. As such, over 350,000 Texans will need to find a new plan for next year. If you are one of them, let Take Command Health help you shop smart for your 2016 health insurance needs.

For those currently on a Blue Choice PPO plan in 2015, this announcement does not impact your 2015 coverage—it just means you can’t buy the same plan again next year. Also, this announcement applies only to the individual market and does not apply to anyone on an employer group plan or Medicaid. As your health insurance advocate, we wanted to walk you through a few of the questions possibly running through your mind:

  1. Why are they getting rid of my plan?

Insurance companies are still in the process of figuring out how to make things work in the era of the Affordable Care Act.  For the past two years, the only PPO plans offered to individuals in Texas were BCBSTX Blue Choice PPO plans--but now that medical claim data is available for the first full year of the Affordable Care Act, the numbers are clear and staggering: In 2014, BCBSTX paid out over $400 million more in claims than it collected in premiums.

It simply isn't sustainable for BCBSTX to pay out so much more in claims than it collects in premiums on these plans.

  1. How do I find a new plan?

In 2016, BCBSTX will transition those on their PPO plans to new plans so that you will not have a gap in coverage.  BCBSTX will continue to offer their HMO plans.  However; instead of just transitioning to BCBSTX's replacement offer, we highly recommend taking 5-10 minutes to go through our site so that we can help you see how your doctor preferences, known conditions and prescriptions fit into the equation.

Open Enrollment for 2016 begins on November 1st so you can begin researching options for next year at that time.

  1. On my current PPO plan, my favorite doctor is "in-network."  Will they be on a new BCBSTX HMO plan?

Unfortunately, some providers who were "in-network" on the Choice PPO plans have declined to participate in the HMO network.

BCBSTX will continue to offer plans on and off the exchange in all of Texas' 254 counties, so if you switch to another BCBSTX plan, you should have access to a doctor anywhere in Texas--it just may not be the same one you've always gone to.

For those currently seeing a provider who will not be "in-network" after your Choice PPO plan goes away, BCBSTX has agreed to "work with you and your providers to minimize the impact to your care, just as if you changed plans for any other reason."

  1. How much more will a different plan cost me?

To be determined.  Currently, BCBSTX proposed rates are under review by CMS--who has to give their stamp of approval before anything gets finalized.  We should have more information about 2016 plan pricing on October 10th when insurance carriers release their plans for next year.

Those on a Blue Choice PPO plan in 2015 will receive a formal notice from BCBSTX by October 1st with additional detail on upcoming changes.

We know change is rarely easy, but we’re here to help with the transition and to keep you informed—our goal is to help you be a smarter health insurance consumer. Ready to find the right plan to replace your old BCBS PPO?


Picture of Angela

Hi, I'm Angela! Angela joined Take Command because she's passionate about helping people. She leverages her extensive consulting experience in the health insurance industry to help Take Command clients understand their policies. Angela is a graduate of Texas A&M and has her MBA from Vanderbilt.