While attending the annual Blue Cross Broker meeting, we were told that the current model of individual health insurance is “financially unsustainable”.

The message is to prepare for major changes in our health plans. The first cataclysmic blow is that Blue CrossBlue Shield of Arizona will not be offering PPO plans in Arizona. The Blue Cross PPO plan model has been the basis for all major health plans in the state for years.

This is a move to more “managed” health care with smaller networks of Physicians and Hospitals. It means that there will only be out of network coverage for emergencies.

We will see deductibles for non-generic prescriptions. All this will be coming with a major price increase.

How about other carriers? Will the consumer have alternatives? The answer is, in the short run, yes. Hopefully there will be other PPO plans. However, if the assumption that the model is unsustainable is correct, then eventually all other plans will do the same.

Remember that Humana is merging with Aetna. Cigna is merging with Anthem. Assurant will stop selling health insurance. There will be fewer carriers to offer creative solutions.

ACA provided guaranteed insurance with no pre-existing conditions. It protects the consumer with an “Out of Pocket” maximum. Preventive care is no cost.

Now to keep costs reasonable, the Insurance Companies seem to be narrowing consumer choices to Hospitals and Doctors who agree to lower pricing. They are insisting that the insured pay more of the initial cost with higher deductibles. Even with these changes, cost continue to rise.

I am going to suggest some concepts for all my clients.

Consider choosing a High Deductible Health Plan with a side Health Savings Account. The account is tax deductible.

Don’t fight the managed health care model, find a network that works for you even if it means changing a Doctor.

Remember with the “out of Pocket” maximum provision, people will ONLY go bankrupt if they do not own an insurance policy. All pre-exiting conditions can be covered and mental health has been moved into a Required Provision.

With proper planning and professional guidance all of us can survive the oncoming changes.

Scroll to Top