Preferred Provider Organization  (PPO)

A PPO plan is a network of medical providers, who join a network and reduce their fees, in exchange for patients. The insurance Industries used these PPO to give their members access to medical care. Then the Insurance carriers started to develop their own PPO networks.

The PPO has been very common to Indiana for the last 25 years. If you had an Individual Health Insurance plan, it was very common you had a PPO network.

The death of the PPO network for Individual plans is just around the corning for Indiana. Maybe in 2 years or even in 2017.

The Affordable Care Act (ACA) has forever changed the individual market in Indiana. With guaranteed issue, no person can be denied health insurance. This has created a huge amount of claims for the insurance industry, especially here in Indiana. The insurance companies have very few options in controlling cost. Limiting network access is really the only option they have left.

This year Assurant Health is closing their Individual division in Indiana and the rest of the country. In 2014, they offered a PPO network through Aetna, this network apealled to a great deal of people.  Those people were high utilization members with large claims, which leads to large losses.

This year 2015, Humana has pulled their PPO plan from Indiana and 14 other states. No one knows the exact reason but one can assume they also had very large losses.

This leads us with one last Individual PPO option for Indiana. United healthcare AKA United Life Insurance. How long will they be able to offer a PPO plan?  I don’t think it will be very long and it could be gone by 2017.

With in 3 years of the ACA going into full effect, Indiana has only one PPO option. This use to be the type of Individual network.

What is in the near future for Indiana insurance networks?

Narrow networks!