Big Changes for BCBS of IL
Big changes have arrived for Blue Cross and Blue Shield (BCBS) of Illinois individual and group health plans. As expected, this is causing stress among some consumers. The state's largest health insurer eliminated its most popular individual plan, called Blue PPO, which has the largest network of doctors and hospitals of any plan the company offers, because it was too costly for the company. The plan is still be available for employer groups only this year.
173,000 members, who are currently enrolled in the Blue PPO, will have to find a new plan. It's a significant upheaval in the Illinois individual market. Two out of every five Blue Cross customers who buy individual or family plans on the exchange or direct from the company are covered by the broad PPO. It's popular despite being the most expensive single-state plan Blue Cross offered in 2015.
Blue Cross said the broad, open access plan was no longer sustainable at current premiums because the medical costs were too high. They noted that if the costs of one plan are high, it raises the premiums for all of the company's individual plans.
The decision to get rid of the broad PPO underscores the intense pressure insurers face to keep premiums low in the individual market. Networks that limit the number of providers help carriers reduce costs.
Last year, Blue Cross said it will automatically switch members enrolled in the broad PPO to the Blue Choice plan. The company said Blue Choice is similar to the broad PPO. The company even refers to Blue Choice as a PPO. But there is one big difference. The broad PPO included every hospital in Illinois — all 209. Blue Choice's network had 78 hospitals this year.
Blue Choice didn't include some prominent Chicago-area hospitals, like Northwestern Memorial, University of Chicago Medicine, Rush University Medical Center, the Advocate Health Care system and the North Shore University HealthSystem.
Carriers can also reduce costs by changing their prescription drug benefits. Blue Cross announced on its website last October that it will be moving its individual plans to a so-called preferred pharmacy network. Policyholders in the Chicago area will have to fill prescriptions at Walgreens or Jewel Osco to get the lowest copays and co-insurance. Pharmacies are often chosen to be in preferred networks because they give health plans larger discounts than other drugstores. The process by which individuals receive prescriptions is also changing to a “step” process where people will be required to use less expensive drugs when first beginning to be treated.
If you have additional questions on how this will continue impacting you throughout the year, chat with an Assurance ‘A’ Team member.
- Potential Impact of HB2509 Bill on Illinois Nursing Homes
- 'Big Brother' for Nursing Homes?
- IL Nursing Homes - Get Ready for the Spotlight
ABOUT THE AUTHOR