Nevada: Anthem Blue Cross *adding* a PPO to the ACA exchange!
2018 MIDTERM ELECTION
Time: D H M S
About a month ago, I crunched Nevada's individual and small group rate hike numbers and concluded that the overall weighted average hike in the Silver State next year (assuming everyone stays put and doesn't shop around) will be roughly 9.6% on the individual market and just 5.3% for small businesses.
Today, the Nevada Appeal ran a story claiming the ACA exchange-only average individual rate hike will be around 8.7%.
Now, it's not the lower rate which caught my eye; the 8.7% figure only includes exchange-based carriers, of which there's only three this year, versus the dozen or so who operate throughout the state (there are 9 more insurance carriers who are only operating off of the exchange).
What I'm puzzled by is this part...which also includes some good news:
The final figures are in and the average increase for individual plans on the Healthcare Marketplace is a modest 8.7 percent. That is low, compared to some other states who were hit hard by rate increases. Competition among providers helped hold rates down here.
There will be just three providers on the individual marketplace this year and here are the average increases for each:
Prominence: 2.94 percent
Health Plan of Nevada: 8.3 percent
Anthem Blue Cross: 11.4 percent
While Anthem has the biggest increase, it is also providing something new for the Marketplace — a PPO plan.
PPO stands for Preferred Provider Organization, which allows the customer to go to a specialist without obtaining a referral from their primary care physician.
Most plans in the state, on the Marketplace, are HMOs or Health Maintenance Organizations that do require referrals.
With the PPO, you can go outside the network to see a specialist, though your amount of coverage will be less. In an HMO, however, you have to pay the full cost of going outside a network.
This is actually excellent, and unexpected news, as several other insurance companies have decided to drop their PPO offerings...notably BCBS of Texas (both on and off-exchange) and BCBS of Illinois (via the exchange only). Anthem Blue Cross adding PPOs to the exchange is great to hear.
UPDATE: According to Emily Holmes in the comments:
Not true on IL. BCBSIL is dropping their broad PPO for individuals on and off the exchange and offering instead a lot less choice. They can call their new offering a PPO, but it is no more than an HMO that eliminates most of the best hospitals in the Chicago area. If you are a small business with group coverage, you get to keep the broad PPO. If you are an individual - self-employed, unemployed, retired - you have to go with the lesser plan or change companies. Discrimination against the individual.
Here's the weird part, though: As you can see in my August 30 Nevada post, Anthem Blue Cross is nowhere to be seen in either the Individual or Small Group tables. I thought that perhaps they were a last-minute addition to the exchange...but even the official Nevada Insurance Dept. website doesn't list them at all. I suppose they could be operating under a different name, but none of the other companies list an 11.4% rate increase anywhere.
Anyway, whatever; good news is good news.
One other bit of news for the Small Business market as well:
While there are no new providers on the individual Marketplace in Nevada, Humana is coming in as a provider on the SHOP portion of the exchange for small business health insurance.
SHOP enrollment has been extremely anemic nationally (except for Vermont and DC, which both have special circumstances), but this is still a good thing.