Let me preface this by saying, this post will not be a post where we bash companies or have any kind of negative comments; we will not be name dropping any of the carriers. The point of our blog is to keep people informed by giving them truthful accounts of our experiences. Many of these circumstances are out of our control but trust me when I say, we hear your comments and concerns and are hopeful things will turn around.
Today’s post is regarding why so many Texas (we are only discussing Texas changes in this post) health insurance brokers are no longer offering Individual/Family health plans. You or someone you know may have called a local broker to get quotes for a health insurance plan for yourself and/or your family only to be told “Sorry, we no longer work in that market. You will have to call the insurance company and/or the Marketplace directly.” This leaves many people frustrated and confused and we totally get it!
This year, our agency had to make the tough decision to stop taking on new clients in the Individual/Family market. This was indeed a very difficult decision for us to make. What we love about being brokers is that we are able to offer multiple products to give our clients unbiased options for a plan that suits their specific needs.
Before we dive into this topic too deeply, let’s rewind to 2015. In 2015, one of the insurance companies that offers health insurance plans in the Individual/Family market made the announcement that they would no longer offer PPO plans in the State of Texas (other states as well but this post is only about Texas) and would only be offering HMO plans for 2016. This was a huge and disappointing announcement for many people – we received A LOT of frustrated calls and emails. After this announcement, many other insurance companies in Texas decided to follow their lead and stopped offering PPO health plans as well.
What is a PPO plan you ask? This definition of a PPO is taken directly from healthcare.gov: Preferred Provider Organization (PPO) – a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
Nutshell definition: A network plan that allows you to go in and out of network and does not require referrals from a Primary Care Provider to see specialists.
For a better understanding, let’s also look at the definition of a HMO. This definition is taken directly from Healthcare.gov as well: Health Maintenance Organization (HMO) – a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
Nutshell definition: A network that requires you to stay in-network for services received and typically requires referrals from a Primary Care Provider to see specialists.
Now, we cannot speak poorly of the decision to no longer offer PPO plans in Texas. There are MANY factors as to why some of these carriers made the decision and we see all sides of the spectrum. However, we had to make the best of the situation to do what we could to remain compliant and still be able to work in this market for 2016. Luckily, we were still able to provide multiple options and assist our clients for 2016 plans.
However, things changed for 2017 health plans. In 2016, many carriers made the decision to either stop working with agents entirely or stop offering commissions during certain time frames for 2017 health plans. Now, we don’t want to sound greedy or selfish but we do still have to make a living. This was a huge blow and disappointment to brokers. We pride ourselves on being able to take time to explain plan benefits, service clients’ plans, and be a go-to source for consumers. We want our clients to call us before they call a 1-800 number; we don’t want them to feel they are on their own when it comes to their health insurance. The decision to no longer work with agents and/or no longer pay agents for their job stripped away our ability to be a broker because we are no longer able to provide multiple options to our clients.
As mentioned above, it was an extremely hard decision to choose to turn people away for Individual/Family health plans. For our clients that are eligible, we can still assist with a group health plan. We are also helping any of our clients that are approaching Medicare eligibility and we also still offer supplemental plans like: accidental, dental, vision, etc.
We are hopeful that we will be able to help clients again in the Individual/Family market soon. We do our best to stay informed and up to date on the changes in the insurance world – and trust me, there are ALWAYS new changes. We wanted to write this post to give people an explanation as to why we decided to make this decision that we hope is only temporary.
If you have any questions or concerns, please feel free to comment or give us a call! Just know, we are constantly staying on top of changes and doing our best to be able to provide our clients with Individual/Family health plan options again.