Are you ready for Open Enrollment for 2016? Under the ACA (Obamacare), individual health insurance plans are issued as a twelve-month contract that begins in January and ends in December. New rates on individual plans will begin on January 1st, and remain in effect until December 31, 2016.
- If you currently have an individual Anthem Exclusive Provider Organization (EPO) policy, Anthem Blue Cross will change your plan to a Tiered PPO for 2016. In Southern California these EPO plans are offered in Los Angeles, Orange, and San Diego counties. Beginning in 2016, plans in these counties will be changed to Tiered PPO plans.
The major difference between EPO and PPO plans is that EPO plans do not offer any out of network benefits. The means you will receive no reimbursement for out of network medical expenses. PPO plans do offer out of network benefits.
Anthems Tier PPO plans split hospitals in their provider network into two categories: Tier 1 and Tier 2. Members utilizing Tier 1 hospitals pay a lower share of cost (co-insurance). The maximum out of pocket (OOP) is the same for both Tiers.
The other major change for Anthem individual plans is they will become part of the nationwide Blue Cross/Blue Shield provider network. Currently, other than emergency services, all providers outside of California are considered out of network, and not subject to reimbursement.
Structurally. deductibles and out of pocket costs will increase for Bronze plans. The maximum deductible will increase to $6,600, and the maximum OOP will increase to $6,850.
The maximum deductible for Silver plans will increase to $2,250, and the OOP to $6,350. For Gold and Platinum, which have no deductibles, the OOPs of $6,200 and $4,000 respectively will remain the same for 2016.
- The 2016 plans offered in Southern California have small rate increases for Bronze and Silver plans, and larger increases for Gold and Platinum plans. In Southern California the lowest rates are still in the Pasadena/San Gabriel Valley, and the highest rates are in San Diego County.
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