Maintenance Notification:
Blue Access for Members and quoting tools will be unavailable from 3am - 6am on Saturday, October 20.
We apologize for any inconvenience.
Maintenance Notification:
Blue Access for Members and quoting tools will be unavailable from 2am - 5am Saturday, October 20.
We apologize for any inconvenience.
Updates Archive
Individual and Family Plans
Affordable Care Act (ACA) 2018 Medical Loss Ratio (MLR) Rebates
Aug. 05, 2019
What Is the ACA’s MLR?
In general, the ACA’s MLR is the percentage of insurance premium dollars that a health insurer spends on health care services and expenses reported as activities to improve health care quality.
The ACA set MLR standards for health insurers. The ACA’s MLR standard for the large group market is 85%. The ACA’s MLR standard for individual and small group markets is 80%.
If an insurer’s MLR doesn’t meet or exceed the ACA’s MLR standard in a certain market segment of a state, the insurer may provide MLR rebates in that market.
MLR Rebates
Blue Cross and Blue Shield of Texas (BCBSTX) will provide MLR rebates in the Texas individual market because we didn’t meet or exceed the ACA’s MLR standard in that market in 2018.
We will provide MLR rebates in the Texas individual market by Sept. 30, 2019.
BCBSTX met or exceeded the ACA’s MLR standards in the Texas small group and large group markets in 2018. As a result, no MLR rebates will be provided in those markets for 2018.
For more information, please read Key Questions About the ACA’s MLR.
CMS Resumes Risk Adjustment Payments
Aug. 6, 2018
BCBSTX is pleased the Centers for Medicare and Medicaid Services (CMS) announced it will resume risk adjustment payments to health insurers. These transfers between insurance carriers are designed to keep costs down and make sure all consumers regardless of health status have access to health insurance and receive the care they need.
CMS Suspends Risk Adjustment Payments
Jul. 16, 2018
On July 7, the Centers for Medicare and Medicaid Services (CMS) announced it will suspend risk adjustment payments under the Affordable Care Act (ACA). BCBSTX is concerned with this decision. Risk adjustment payments are transfers between insurance carriers. They are meant to keep costs down and make sure all consumers have access to health insurance and get the care they need, no matter if they’re healthy or not. There is no immediate impact to our members. We will continue to review what this may mean for our members and will post more information here.
Proposed Short-Term Health Plan Policy
Mar. 1, 2018
On Feb. 20, the Departments of Health and Human Services, Labor, and the Treasury proposed a new rule on short-term health insurance plans. For now, nothing changes. The federal government still needs to gather and review feedback from the public. Once we know what the final proposal is, we’ll let you know how it may impact you.
Developments on the Tax Reform Bill
Dec. 04, 2017
The Senate passed the tax reform bill on December 2. The differences between the Senate version of the tax bill and the one passed by the House must be settled before it's signed into law.
Nothing will change for now. We encourage customers to keep shopping for or renew their coverage during this open enrollment period which ends December 15. There's only one open enrollment period each year so, customers need to purchase by December 15 to make sure they have coverage in 2018.
Open Enrollment for Individual Health Plans is Here
Nov. 01, 2017
For more than 80 years, Blue Cross and Blue Shield of Texas (BCBSTX) has been committed to providing access to quality, cost-effective coverage to as many people as possible, and we’re once again ready to help consumers in Texas choose the individual coverage that best meets their needs. We’re proud to be the only insurer offering retail products statewide in all 254 Texas counties, with plan options both on and off the exchange. This year’s open enrollment is from Nov. 1 – Dec. 15, 2017, and we have many resources available to help consumers shop for a plan, including:
- BCBSTX Product Specialist – available every day from 8 a.m. - 10 p.m. Central Time at 855-813-1465
Our business starts and ends with our members, and BCBSTX is ready to serve as a go-to resource for customers for help reviewing all their choices and finding the best fit for their health care needs.
Important Actions on Health Care from the White House
Oct. 25, 2017
Recent executive action, along with the announcement to stop funding of cost-sharing reduction payments (CSRs), has once again put a spotlight on health care. Regardless of the action taking place in Washington, D.C. one thing is certain: our continued focus on providing access to health care in Texas.
The decision to stop the CSR payments doesn’t impact our market participation. BCBSTX has accounted for the uncertainty around the federal government’s funding of the member’s CSR benefit in our rates.
It's also important to note that the Administration's decision on CSRs isn’t related to the Advanced Premium Tax Credit (APTC). The APTC is federal aid available for people who earn less than 400 percent of the Federal Poverty Level (FPL), and lowers the monthly premium for Marketplace (on-exchange) plans. The APTC is paid by the federal government straight to insurers each month. No payments are made directly to consumers.
We’ll share more news about the Executive Order and next steps as it becomes available.
Recent Notice about Updates to Our Individual Health Plan Options
Oct. 02, 2017
Blue Cross and Blue Shield of Texas is proud to again offer a variety of health plan options for individuals and families in every county of Texas in 2018. For 2018, we’ve simplified our health plan options to make them easier for you to review and select the coverage that best meets your needs.
While our plans will have fewer options at each metallic level, we’ve worked to make sure you get the same quality of benefits you expect from BCBSTX. There won’t be any major changes to our provider networks.
You may have received a legally-required notice informing you that you’ll need to select a new individual plan for 2018. There’s nothing you need to do right now. To help make the transition as seamless as possible we’ve taken the step of identifying a recommended plan that is similar to your current coverage. You will be automatically enrolled in this similar plan, or you can select any plan from our 2018 offering during the Open Enrollment period, which runs from Nov. 01, through Dec. 15, 2017.
Details on all 2018 plan options will be included in an enrollment package each member will get in the mail before open enrollment. We understand you may have questions, and we’re committed to helping you find the plan that best meets your needs. We have increased the number of sales and customer service representatives during open enrollment to offer support throughout the enrollment process.
You can reach a Customer Advocate at the number listed on the back of your BCBSTX member ID card Monday – Friday, 8 a.m. – 8 p.m. (Central Time), 8 a.m. – 6 p.m. (Central Time) on Saturdays and 10 a.m. – 6 p.m. (Central Time) on Sundays. You can also check this webpage for further updates.
2018 Individual Market Participation Update
Sept. 27, 2017
BCBSTX is proud to announce that we will continue to offer consumers health insurance options both on and off the individual marketplace in 2018. Specific plan, network and benefit information will be available closer to the open enrollment period that begins on Nov. 01, 2017.
We remain committed to working with lawmakers, regulators, providers and the entire health care system to ensure a stable, sustainable individual marketplace and to improve the quality and cost of care for all our members.
Health Care is Complicated, Understanding Individual Insurance Rates
August 01, 2017
Blue Cross and Blue Shield of Texas filed proposed rates and products in the individual marketplace with the hopes of continuing to offer quality, cost-effective coverage to Texas in 2018.
On August 1, the federal government released the rates from insurers across the country who submitted 2018 products in the individual insurance market. While this may be the subject of conversation and media attention, it’s important to keep a few things in mind:
- Rate submission and review is an annual process and necessary to participate in the individual marketplace.
- Rates should be viewed in context, or include, any premium assistance for those who may receive subsidies. Actual out-of-pocket costs will differ based on the financial assistance consumers receive from the government to offset their total monthly premium cost.
- There is still a lot of uncertainty on the rules and regulations of the individual market for 2018. Our 2018 product pricing reflects that uncertainty and the associated risks that exist within this marketplace. We will continue to work with legislators, regulators and other stakeholders toward getting the necessary certainty around issues like the continued funding of cost-sharing reductions ("CSRs") and mechanisms that encourage broad and continuous coverage.
- Our rates also account for keeping pace with escalating health care costs and the growing use of that care. If we want to control premiums, then we must focus on the cost of care and the amount of care being used.
It is important to note that while we have submitted rates, our level of participation has not yet been finalized. If we receive regulatory certainty within an acceptable time frame we will review and, where appropriate, adjust our rates if time allows.
Please continue to visit this page for updates to our 2018 products and services in the individual marketplace.
Medicare and Medicaid
Navigating Medicare Annual Election Period
Oct. 16, 2017
The Medicare Annual Election Period (AEP) is now under way, and Blue Cross and Blue Shield of Texas (BCBSTX) is proud to again offer a variety of health coverage options centered around optimized networks, flexibility and affordability.
During AEP, which runs from Oct. 15 through Dec. 7, Medicare-eligible customers can sign up for a plan or make changes to their current coverage. We know that choosing a health care plan can be hard. That’s why BCBSTX is committed to helping you understand your options and pick the best coverage for your unique needs.
Plan benefit and network information for 2018 BCBSTX Medicare plans is now available at www.bcbstx.com/medicare. We also have dedicated Medicare experts ready by phone at 1-877-213-1821, every day from 8 a.m. – 8 p.m. to answer questions and offer personalized enrollment help. Or, you can find a licensed, approved BCBSTX agent in your area at www.bcbstx.com/medicareagents.
Need more help? Find an educational seminar in your area at www.bcbstx.com/medicare/seminars.
Our top priority is providing access to care for our Medicare members to help them get and stay healthy. We’re here as a resource for you each step of the way through AEP and beyond.
Employer Based Plans
Affordable Care Act (ACA) 2018 Medical Loss Ratio (MLR) Rebates
Aug. 05, 2019
What Is the ACA’s MLR?
In general, the ACA’s MLR is the percentage of insurance premium dollars that a health insurer spends on health care services and expenses reported as activities to improve health care quality.
The ACA set MLR standards for health insurers. The ACA’s MLR standard for the large group market is 85%. The ACA’s MLR standard for individual and small group markets is 80%.
If an insurer’s MLR doesn’t meet or exceed the ACA’s MLR standard in a certain market segment of a state, the insurer may provide MLR rebates in that market.
MLR Rebates
Blue Cross and Blue Shield of Texas (BCBSTX) will provide MLR rebates in the Texas individual market because we didn’t meet or exceed the ACA’s MLR standard in that market in 2018.
We will provide MLR rebates in the Texas individual market by Sept. 30, 2019.
BCBSTX met or exceeded the ACA’s MLR standards in the Texas small group and large group markets in 2018. As a result, no MLR rebates will be provided in those markets for 2018.
For more information, please read Key Questions About the ACA’s MLR.
Update for Our Small Business Customers
Oct. 02, 2017
As we're preparing to sell 2018 plans and service our clients, small group employers who currently offer BCBSTX coverage to their employees through the Small Business Health Options Program (“SHOP”) will receive notifications that BCBSTX will not participate on the SHOP exchange, effective Jan. 1, 2018; however, it's important to know that members currently enrolled in a SHOP plan will have coverage through the full term of the existing contract.
We are also sending letters to employers and members to let them know that certain off-exchange small group plans as well as other group plans are being discontinued. Federal regulations require that small group plans must be discontinued if they are significantly modified.
We will continue to serve the Small Group Market with an array of robust off-exchange plans that enable employers in Texas to continue offering quality, cost-effective coverage from BCBSTX.