Anthem Blue Cross Blue Shield cuts individual plans from health - WAOW - Newsline 9, Wausau News, Weather, Sports

Anthem Blue Cross Blue Shield cuts individual plans from health exchange in parts of Wisconsin

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(WBAY)-- Anthem, the Blue Cross and Blue Shield (BCBS) licensee in Wisconsin, has decided to completely pull out of the health care exchange (individual plans) market place in Milwaukee, Racine and Kenosha counties starting January. Anthem is also significantly cutting back on the number of available exchange plans in 34 Wisconsin counties, which include the Fox Valley, according to Scott Larrivee, Public Relations Director at Anthem Blue Cross and Blue Shield in Wisconsin.

“Anthem individual members in these [Milwaukee, Kenosha and Racine] counties will need to select a new health insurance plan with a different company for 2016,” Larrivee said, noting that Anthem is communicating with members to make sure they understand their options.

Larrivee also pointed out that this move will not impact all of their market segments, including large and small groups, Medicare, Medicaid, or specialty product offerings.

Anthem’s elimination of the consumer direct (individual) plans in three Wisconsin counties goes one step further than a move by other BCBS plans. Blue Cross Blue Shield of Illinois and Texas announced earlier this year they would no longer be offering individual PPO plans, but would still continue to offer HMO plans.

PPO plans typically have better coverage for consumers by offering both in and out of network coverage, and don’t always require selection of a primary care physician as most HMO plans require.

Blue Cross and Blue Shield is unlike its competitors in that United Health Care, Aetna and Cigna remain the same company in all states in which they serve. The Blue Cross and Blue Shield System consists of 36 independently operated Blue Cross and Blue Shield member companies.

Anthem also serves as the BCBS licensee in more than a dozen states including Colorado, New York and California.

Exchange products (health insurance plans) are created on a state by state basis. So Aetna, just like BCBS, can decide to not participate in a state’s exchange.

Perhaps oversimplified, the Blue Cross Blue Shield system is set up similar to a Pizza Hut restaurant. The branding is national, but stores are independently owned and operated.

Of course pizza isn’t regulated anywhere nearly as much as the Blue Cross Blue Shield licensees.

Each BCBS licensee, such as Anthem, faces federal, state and local regulations in addition to the requirements set by the Blue Cross and Blue Shield Association.

Anthem’s move is in the midst of potential mergers between the big four health insurance giants.

In July, Anthem agreed to acquire Cigna in a $48 billion deal and on Oct. 19, Humana’s stockholders moved forward with the $35 billion acquisition of Aetna.

Both deals are subject to approval by Federal and state regulators.

On Oct. 21, Hillary Clinton questioned how consumers might benefit from a merger among health insurance company giants.

“Too often the companies end up pocketing profits rather than passing savings to consumers,” Clinton said.

Although questions remain as to why Anthem decided to completely pull out of three Wisconsin counties and scale back in 34 others, Anthem says that the company “remains committed to serving the entire state of Wisconsin and to participating in the exchange marketplace,” Larrivee said.

Anthem BCBS plans will still be available on the health care marketplace in following 34 counties in 2016:

Brown

Calumet

Dodge

Door

Fond du Lac

Green Lake

Jackson

Jefferson

Kewaunee

La Crosse

Langlade

Lincoln

Manitowoc

Marathon

Marinette

Marquette

Monroe

Oconto

Oneida

Outagamie

Ozaukee

Portage

Shawano

Sheboygan

Taylor

Trempealeau

Vernon

Walworth

Washington

Waukesha

Waupaca

Waushara

Winnebago

Wood

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