There are thirteen health insurance companies offering plans in Arizona. Many were not here before ObamaCare became the law of the land. Of these thirteen insurance carriers, most all will only be offering HMO plans effective January 2016. Until ObamaCare and for many years, most health insurance companies offered PPO plans. PPO stands for Preferred Provider Organization. If you went to any medical provider in the country that was in your PPO network, you had a limited out-of-pocket expense — perhaps you paid $20 or $30 for a doctor visit.
Effective January 1, 2016, almost all PPO plans have disappeared. Most carriers will only offer HMO plans. Many of these HMO plans are not the HMO plans of the past, where you had to select a primary practice doctor and see that doctor for all of your care, and you had to get a written referral from that doctor to see a specialist. These days, most HMO plans are what are called “open access HMOs” — you don’t need a referral, and with many you don’t need to select a primary practice doctor. You can see any provider within your network at any time with no referral necessary.
With the disappearing PPO plans, you were able to visit an OUT-of network provider and still get some of that doctor’s fee paid by your insurance company. With most of these new HMO plans, your health insurance company will pay absolutely nothing if you use a provider that is not in your network. And with most of the new HMO plans, the networks are much smaller than the older PPO networks, so you will not have nearly as many providers to choose from. You’ll need to make sure that you use an in-network provider or you’ll end up paying 100% of your provider’s bill out of your own pocket.
The reason this is happening is due to the requirement, under ObamaCare, that all health insurance companies must insure everyone who applies for a policy. Your pre-existing health conditions do not matter. If you need a heart transplant, you can apply for a policy from the health insurance carrier of your choice and get your heart transplant on the day your policy becomes effective. This is costing the health insurance companies a lot of money, and there is nothing these health insurance companies can do about this except to find ways to reduce their expenses. One way that they will do that is to limit the lengthly list of providers to a much smaller number of doctors and hospitals.
The health insurance carriers here in Arizona lost many millions of dollars since the Affordable Care Act (ObamaCare) was passed, and if they want to stay in business, they will do whatever it takes. See this Arizona Republic story that appeared on October 3, 2015: “Why 4 major Arizona insurance carriers are dropping PPO plans in favor of HMO plans.”
To see the rates and policy descriptions for the 2016 health insurance plans available here in Arizona, contact Lehrman Group after October 20th at (800) 600-9663. Or request a rate quote here.