ALBUQUERQUE, N.M. — Nearly 8,000 New Mexicans who shop on the state health exchange for insurance coverage next year won’t be able to buy preferred provider organization plans, which allow relative freedom to choose hospitals and doctors.
New Mexico Health Connections announced Monday that it will offer only health maintenance organization plans, or HMOs, which restrict participants to a contracted provider network.
Health Connection’s decision, coupled with an earlier decision by Blue Cross Blue Shield to largely pull out of the individual market, means about 23,900 people with PPO plans on and off the exchange will have to find new coverage for 2016.
Health Connections is dropping the three PPO products it now offers to individuals, although it still will offer PPO coverage for employee groups, Health Connections CEO Martin Hickey said.
Hickey said the Health Connections decision puts it on the same footing as other insurance companies in New Mexico that are offering only the less expensive HMO plans on the health exchange.
Lisa Reid, director of life and health at the state Office of the Superintendent of Insurance, said dropping PPO plans appears to be a nationwide trend.
“It’s probably because insurers have less control over costs with PPO plans because they (customers) can pick the doctors they want,” Reid said.
Health Connections currently has two silver PPO individual plans and one gold individual PPO plan, which will be effective through Dec. 31. It will work with those affected by the change, Hickey said.
Its HMO plans in southern New Mexico will still cover treatment with providers and hospitals in El Paso, he said. Health Connections also will work with individuals who have medical conditions that may require treatment out of state, such as at the MD Anderson Center in Houston.
“If it is medically necessary, we’ll get them there,” Hickey said.
Health Connections has about 1,900 PPO members, 1,230 of whom bought insurance through the exchange. Blue Cross Blue Shield has 22,000 members with PPO plans, 6,500 of whom bought plans on the exchange.
Only one company, Celtic Insurance, will offer an individual PPO plan off the exchange in 2016. But people who buy insurance off the exchange aren’t eligible for subsidies to help pay premiums.
Individuals can shop for new plans through the exchange, where they may be able to get subsidies to help cover premium costs. Open enrollment begins Nov. 1, and a new plan must be chosen by mid-December to ensure coverage on Jan. 1.