California-based Anthem Blue Cross announced all individual and family Anthem PPO Plans discontinued on January 1st will be replaced by an EPO plan. One rumor suggests this is an HMO plan, in disguise. Are such rumors true or false?
Let’s consider Anthem’s statements for the changes coming coming to California individuals in 2017:
- All 2016 Tiered PPO plans will be discontinued
- PCP selection required for all plans
- Replacement plans do not have out-of-network coverage (except for urgent care or in the case of an emergency)
All 2016 Anthem PPO plans discontinued
Are you covered under a California-based individual or family plan from Anthem Blue Cross. The bad news is out: Your health plan is going away in 2017, and now is the time to take action, before open enrollment closes. For most California individuals, this is December 15th, assuming you want a January 1st effective date. Read additional features below
Opinion: Blue Shield of California seems committed to supporting the good features of the Affordable Care Act. In many California counties, Blue Shield is the only insurer to offer a true PPO plan, adding credibility to their Not-For-Profit status and commitment to support the future of the ACA. (read the entire article from Coverage California)
Primary Care Physician will be required for all individual Anthem health plans
If you are covered under a California-based Anthem Blue Cross plan discontinued in 2017, you will be impacted whether you purchased your plan directly from Anthem or through the Covered California exchange. These plans will be replaced by a new EPO product, which (like an HMO), require you to select a PCP (primary care physician) from Anthem’s list of participating providers. Caution: This list excludes Sutter and PAMF providers in most situations. If you require a plan that covers PAMF/Sutter providers, now is the time to take action, before open enrollment ends. At the time of this writing, Blue Shield of California was still contracted with most PAMF and Sutter Doctors.
No Out-of-network Coverage
If you are currently covered under an Anthem Blue Cross PPO plan discontinued and replaced by the new EPO on January 1st, you will lose out-of-network coverage (except for emergencies and urgent care.
EPO plans operate like a PPO, but do not have out-of-network coverage except for urgent care or in the case of an emergency.
Should you keep the EPO plan or switch to Anthem’s competitor, Blue Shield of California Quote? The advantage of Anthem’s product is its low cost. Of course, it is low cost because Anthem is taking away many of your health care options. A big decision point is whether or not you are prepared to make the commitment to a Pathway network Primary Care Physician by “selecting” one for each family member: Search for them here:
In summary, Anthem PPO plans discontinued and replaced by an EPO reduces your ability to seek different specialists and providers for your family’s care. However, the rumor is false: The EPO is not the same as an HMO, but it’s a pretty close cousin. For example, losing out-of-network coverage, and choosing a PCP are both hallmarks of an HMO.
Bottom-line, it’s your decision unless you do nothing: Because all Anthem PPO plans discontinued will be transferred to the EPO. If this bothers you, then take control and check out Blue Shield’s PPO.
In many California counties, Blue Shield is the only insurer to offer a true PPO plan, adding credibility to their Not-For-Profit status and commitment to support the future of the ACA. (read the entire article from Coverage California)