Friday, November 6, 2015

Texas Health Insurance Plan Information - 2016

For 2017 information, please visit our website:  www.InsTexas.com






For On-Exchange Plans:


Compare ALL plans.......side-by-side.......HERE




On-Exchange =
You can qualify for a Monthly Tax Credit from the govt to help lower your monthly insurance premiums.  These tax credit are paid directly to your insurance company each month for you.

 Our Quote Engine (above link) will quickly help you see if you'd qualify for a tax credit.
You can use it anonymously.
We'll never know you've been there....or what you entered.
No one else will know, either.

 Tax credits are reconciled on your 2016 federal tax return (that you'll file in 2017).  
If they paid you too much (...each month...to your insurance company), you'll owe them money back (with your tax return).
If they didn't pay you enough, you can get a refund with your tax return.

 For more details (including links to tax credit information), please visit our website:

www.InsTexas.com

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For Off-Exchange Plans:  

 Get Quotes HERE


Run-a-quote & compare plans side-by-side at above link.
But, you should use the Direct Insurance Company links below for fastest & easiest online enrollments.
Off-Exchange = 
- You can't qualify for a Monthly Tax Credit (usually because your Adjusted Gross Income is too high........or you have access to group coverage at work ...or at spouse's job).
- And, you want to avoid interaction with the govt as much as possible.
If you simply want to compare Off-Exchange Plans side-by-side (without visiting each insurance company's site below), use our Off-Exchange Quote Engine HERE
But, you cannot enroll on our Off-Exchange Quote Engine any longer.
It was too confusing.
So, we've disabled it.
Use the Insurance Company links (below) for enrollment.


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Networks


Be sure to check the networks for your doctors & hospitals!
Most 2016 networks are much smaller than they were in 2015.

Most 2016 plans will be HMO's & EPO's that have NO out-of-network coverage! ...(except for serious emergencies).

You must, also, verify with your doctor...that they will accept your ACA policy coverage......that they ARE in your network!!!

We can't simply trust an insurance company's Provider Finder Search Engine any longer!

 You don't want to end up paying the entire bill (with no insurance coverage) because your doctor or hospital isn't in your network!

 Our world is changing.....in 2016 !
PPO networks will be scarce....and very expensive!

 HMO (and EPO) networks will not be easy to deal with.
But, they're better than no coverage at all.

See Provider-Finder Network Links below for each Insurance Company



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Meds


If you take meds, you can use the Rx Formulary Lists (at insurance company links below) to see if your med will be covered in 2016.
Some of the companies provide a nice Rx Search Engine.  
Others don't.  
But, they'll all have a "list" of some sort.
On PDF lists, just use Control-F (to find your med).

Many expensive meds have been removed from the lists.....for 2016!
Others have added hassles....like:
  • Prior Authorization required (or your med isn't covered)
  • Step Therapy required before they'll cover your med....(...Try a cheaper med 1st)

See Rx Formulary (Drug) Lists....Links below for each Insurance Company
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Bank Drafts & Policy Cancellations


Stop your 2015 bank draft (by mid-December)  if you'll be changing insurance companies on Jan 1st.

We'll cancel your old policy for you....if we know that you've purchased a new 2016 policy from a different insurance company.

 We should not formally request a cancellation until we can clearly see that your new 2016 policy is effective....and that all is in order.  So, we'll handle your cancellations on (or shortly after) Jan 1st.

 Just don't pay for the old policy by mistake.




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Ruth Stewart Agency

Ruth's NPN number (for the govt):  1103110

Toll Free Line:  888-777-0474
Houston Line:  713-932-9072

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Hospital Plan....to supplement High-Deductible Plans: 

                                                                          Click Here


Less than $30/month for $6350 Hospital Benefit.
Paid direct-to-you for a hospitalization.

See:  Out-of-Pocket Protection Plan...on 1st screen...to run-a-quote.


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Aetna


Aetna Quotes & Enrollment - Click Here


Aetna is offering EPO Plans in many Texas counties in 2016 with
  • No PCP (Primary Care Physician) selection required
  • No referrals needed (from a PCP) to see a specialist
  • But, NO out-of-network coverage!

Aetna Provider Network - Here 


Off-Exchange - Use the first link you'll see on the screen
On-Exchange - Use the 2nd link you'll see on the screen



Aetna Rx Formulary List - Here




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BCBS-Tx


BlueCross Quotes & Enrollment - Click Here


BlueCross will no longer offer PPO Plans to new policyholders in Texas this year.

If you own an old "Grandfathered" policy (with the nice, large PPO network), you can keep your old PPO-network policy (if the rate increases don't run you off).
If you own a newer ACA-compatible policy (.....you bought or changed your policy since the ACA-Obamacare Law was passed in March, 2010), you're being forced into the new HMO plans in 2016...........unless you choose a new insurance company for 2016...that offers PPO or EPO plans.

 EPO plans are very, very similar to HMO's, though!  So ask questions before you jump out of the frying pan into the fire.  
Or, keep reading for guidance.

 All 2016 plans are different!  Each has their own set of rules.  Many of them are hybrids (part HMO & part EPO).

 HMO = Health Maintenance Organization
EPO = Exclusive Provider Organization
Since most 2016 plans are hybrids, these terms are almost meaningless (in 2016).

BlueCross will offer 2 different types of HMO Plans in 2016:

  • HMO Plus Plans........... with out-of-network benefits
  • Regular HMO Plans with no out-of-network benefits


Out-of-network benefits with the HMO Plus Plans:
  • No out-of-pocket maximums!......unlimited liability (out-of-your-pocket)
  • $15,000 Deductible for Individuals
  • $45,000 Maximum Family Deductible - Plans with more-than-1-family-member
  • After deductible, co-insurance applies
  • CoInsurance = 50%.....................(They pay 50%...You pay 50%)
  • Specialists who are referred by your PCP....AND approved-for-the-visit... ...by BCBS-Tx.....will be covered as if the visit is IN-network


Note:

If your favorite doctor is not in any of the networks, consider an HSA:




For all BCBS-Tx ACA-HMO plans:
  • You must select a PCP (Primary Care Physician) in the HMO network who will coordinate all of your care.
  • You must get a referral from your PCP to visit a specialist (except ObGyn visits)
  • All 2016 plans will use the Blue Advantage HMO network (BAV)

BlueCross HMO Network - Here 

    Choose:  Blue Advantage (BAV)


BlueCross - Rx Formulary List - Here


BlueCross - Rx Search Engine

Choose:

  • Continue without login   (at LogIn Box)
  • BCBS - Texas
  • Medicines   (Tab near top)
  • BCBSTX Marketplace 5-Tier Generics Plus Drug List

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Cigna


Cigna Quotes & Enrollment - Click Here


Cigna will offer different plans in different areas of Texas.

- DFW areas - Focus Network EPO Plans:

  • No PCP (Primary Care Physician) selection is required
  • No referrals required to see a specialist
  • No out-of-network coverage! (except emergencies)

Network includes most Baylor Hospitals (but not all).
Also includes:
  • Baylor Physicians
  • HealthTex Providers

- Houston Metro areas - Connect HMO Plans:

  • PCP (Primary Care Physician) selection is required
  • Referrals are required to see a specialist (except ObGyn visits)
  • No out-of-network coverage! (except emergencies)
Even though we think of HMO Plans as having smaller networks (which is usually true), the Houston-area HMO network is a very-large network...because it was built to service many large corporations, including Harris County employees.

This may turn out to be the largest network of doctors & hospitals available to residents of the Houston-Metro area.
We were not given adequate time to evaluate networks....for 2016.
Most of the 2016 changes were announced just days before Open Enrollment (November 1st).
We've been scrambling to put this massive puzzle together with inadequate time to do it all !!!
It's NOT Cigna's fault, though!
They were one of the 1st to give us their plan (and network) details for 2016.
And:
They've given policyholders fewer nightmares than most of the other large insurance companies.
But, Cigna had NO HMO plans in 2014 & 2015 (in the private market).
This is their 1st year to offer HMO Plans (for individuals/families).

HMO's (and EPO's) have caused the most nightmares (as far as networks are concerned).
.....United HealthCare's EPO network was the worst!
.....They call it an EPO......but it works just like an HMO.

 Cigna's Houston HMO network does include Methodist Hospitals (if that's a priority for you).


- Certain (limited) other areas of Texas - Vantage EPO Plans:

  • No PCP required
  • No referrals required
  • No out-of-network coverage!  (except emergencies)
When you enter your zip code (at Cigna link above), you'll know if your area offers these plans (or not).

Cigna Networks - Here 


Cigna Rx List -          www.cigna.com/ifp-drug-list


Cigna Rx Step Therapy Details 


Cigna No-cost Preventive Meds - Here

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Community Health Choice   (CHC)


 Community Health Choice - Quote & Enroll Here



Community Health Choice offers HMO Plans in South-East Texas areas....including these counties:
  • Brazoria
  • Chambers
  • Fort Bend
  • Galveston
  • Harris
  • Jefferson
  • Liberty
  • Montgomery
  • Orange
  • Waller
Their HMO plans are truly HMO-hybrids! ....with better-than-most-HMO benefits!... ...and a nice HMO network, including:
  • Memorial Hermann Hospitals
  • St Lukes Hospitals


If your doctor is in their network, you'll be very happy with CHC.

Only 2 of their plans will offer Kelsey Seybold Clinic access:
  • Gold CoPay Plan 001
  • Silver CoPay Plan 002
Remember that IF you qualify for Cost-Sharing-Reductions (lower deductibles & better benefits), you can only get those lower deductibles & better benefits IF you buy a Silver Plan !!!

CSRs (Cost Sharing Reductions) are only available for those who fall between 100% and 250% of the FPL (Federal Poverty Level).
For a single individual, that's:
   $11,770 to $29,425 Adjusted Gross Income (in 2016)



CHC's Deductible Plans:
  • Gold Plan 005 ........with $500 Deductible
  • Silver Plan 004 ......with $1500 Deductible
  • Bronze Plan 003 ...with $4000 Deductible
These 3 plans give you 3 PCP CoPays per person before meeting your deductible!
The quote engines don't clearly show this.
Maybe the govt won't let them.
But, this is a very-nice added benefit to be aware of.
Especially since they have some of the best prices available in South-East Texas.

At 1st glance, you might think:  
     "Oh, it's cheap coverage, but I don't get any 1st-dollar co-pays."
But, you do!
And, superior Customer Service, too!
And, a nice network of doctors & hospitals.

We've had no customer complaints about CHC in prior years!
That says a lot!
And, they are one of the few companies that did not lose money in 2015!
Most companies lost millions.


Community Health Choice (CHC) Plans have:
  • No PCP requirements.  They encourage you to pick a PCP, but don't require it.
  • No need for a referral to see a specialist
But, there is no out-of-network coverage (except emergencies).



CHC Networks - Here


Choose:
- Deductible Plans.......or.......CoPay Plans
- Community Marketplace Network ...or... Kelsey Seybold Network
......If you want to use Kelsey-Seybold Clinics, choose their network

CHC Rx Formulary List - Here

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Humana

Humana Quotes & Enrollment - Click Here


Humana will offer different plans in different areas of Texas.

There will be one PPO-network plan available in certain areas of Texas.
It will be a Bronze Plan.......with a very-high deductible.
And, it won't be cheap.

You can click-for-quotes now....at Humana link above.
Humana's Bronze PPO Plan will appear in your quotes (if available in your area).

By entering your zip code, you'll know which plans are available in your area.

You can use Concentra Urgent Care facilities nationwide & be in-network!


Humana Rx List - Here

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Memorial Hermann Health Plans


Memorial Hermann Quotes & Enrollment - Click Here



Memorial Hermann will offer PPO-network plans in only 7 Texas counties:
  • Brazoria
  • Fort Bend
  • Galveston
  • Harris
  • Montgomery
  • Walker
  • Wharton


 If you are traveling outside of these 7 counties:
- You'll have access to Teledoc 
....24 hours/day
.....7 days/week
.......You can access a doctor who can prescribe rx's for:

  • Cold & flu symptoms
  • Allergies
  • Bronchitis
  • Skin problems
  • Sinus problems
  • Respiratory infections
  • And other minor conditions

For dependents who live outside of the local service area...
...like college students:
- In-network benefits are available using the PHCS Healthy Directions PPO network



PPO Plans - Out-of-Network Benefits:
  • Deductibles are much higher than in-network deductibles
  • Each plan is different - OON deductibles can be $5,000 to $10,000
  • CoInsurance (after deductible) = 50%
  • Max out-of-pocket varies by plan
  • See the Summary-of-Benefits for each plan to view specific out-of-network benefits for that plan.

Memorial Hermann will only offer OFF-Exchange coverage in 2016.
   You can't get a tax credit with Off-Exchange plans.




Memorial Hermann Rx List - Not available yet

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Molina


Molina is lowering their rates for 2016!
BUT:
Molina's hospital network is very small in most areas of Texas !!!

Do not choose a Molina plan until you look at the doctor/hospital network:
See links below.
     

Molina's plans are HMO's....with NO out-of-network coverage (except emergencies).

Many of their SBC's are being changed right now.
SBC = Summary-of-Benefits

So, be patient....and we'll see what their plans have to offer soon.


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Oscar Health Plans


Oscar Quotes & Enrollment - Click Here 



Oscar is new to Texas this year.

They offer many 1st-dollar benefits (with deductible waived).

 Their prices are low in many Texas areas!

Oscar's plans are EPOs with:

  • No PCP selection required!
  • No referrals needed to see a specialist
  • But, no coverage out-of-their-EPO-network (except emergencies)


 Oscar will offer plans in:

  • DFW areas
  • San Antonio areas




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Scott & White Health Plans


Scott & White Quotes & Enrollment - Click Here   
Scott & White will offer PPO Plans in:
  • Some DFW areas
  • Many Central Texas areas
Their out-of-network benefits vary by plan.
See the Summary-of-Benefits for each plan offered to view out-of-network benefits.
The Scott & White PPO Plans will be the best choice for many who find that their favorite doctor or hospital is not in any of the networks.  
At least you'll have decent out-of-network coverage (compared to other companies... ...that have very-high out-of-network deductibles & max-out-of-pockets).

 You should also consider an HSA.
More Info about HSAs Here


Scott & White Provider Networks - Here


Scott & White Rx List - Here

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United HealthCare     (UHC)


UHC Quotes & Enrollment - Click Here  


United HealthCare isn't handling the ACA-computer integration very well at all (again this year).  
Their quoting system malfunctions daily.

The networks aren't always accurate.  Just because it lists your doctor/hospital, doesn't mean that they are in the network.

We've had numerous billing & bank drafting issues over the past year, also.

Right now, we can't recommend a good experience with UHC for 2016.

They have been a wonderful company to do business with (before ACA).   We hope they'll get back on track.  But, haven't YET.

They have wonderful prices, but the trade-off may not be worth the savings in 2016.



Off-Exchange Plans:


Choice EPO Plans.................only available in certain areas of Tx
  • No PCP required
  • No referrals required to see a specialist
  • No out-of-network coverage (except serious emergencies)
  • Use any doctor in the Choice Network........nationwide

    
Compass Balanced EPO Plans......only available in certain areas of Tx
  • PCP (Primary Care Physician) required 
  • Referral required to see a specialist (except ObGyn)...or benefits reduced 20%
  • No out-of-network coverage  (except serious emergencies)

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On-Exchange Plans:

    Compass EPO Plans 
  • PCP (Primary Care Physician) required
  • Referrals to see specialists required
  • No out -of-network coverage (except emergencies)

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Off-Exchange Networks

UHC - Choice Network - For Choice Plans ONLY


UHC - Compass Balanced Network Plans ONLY


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On-Exchange Network

UHC - Compass EPO Network - Compass Plans ONLY


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UHC - Rx Lists......Use the Rx link provided in your quotes!

...............................There are different Rx lists for different plans.






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 Yes, there are a few companies missing.

 We probably won't offer coverage from those companies.

 Too many technical difficulties (or other problems).
Note:

 All companies are experiencing unprecedented technical difficulties this year!

 If you can wait until December to enroll, you should have a smoother enrollment.


Enroll By..............................For an Effective Date of:

December 15th..........................Jan 1st
January 15th..............................Feb 1st
January 31st..............................March 1st


Open Enrollment for 2016 coverage ends on Jan 31st.

After that, you can only buy coverage if you have a Life-Changing Event.



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Thanks for your patience with all of the technical difficulties & delays we are experiencing this year!





Ruth's NPN Number (for the government site):  1103110
Agent:  Ruth Stewart

Remember that you'll only have (get to keep) an agent (when using the govt site) IF you enter your agent's info in the tiny (almost hidden) box called:
   - Is anyone helping you?

It doesn't cost you an extra dime to have your own personal agent.
If you don't pick an agent, the govt is your agent.


Toll Free Line:  888-777-0474

Houston Line:  713-932-9072











Yes, this is the same picture you've seen for years.
Ruth won't let us take her picture any longer.
She says that she's aged 20 years in the last 2 years.
And, that no one wants to look at an old lady.




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