Anthem PPO to EPO Change for 2017

By John Hansen

Many Californians’ Will Lose Their PPO Coverage if They Don’t Act Quickly

shutterstock_483319285As a reminder, effective January 1, 2017, some consumers who have Anthem Blue Cross Covered California will have a plan change from a Preferred Provider Organization (PPO) to an Exclusive Provider Organization (EPO). Covered California consumers who were enrolled in certain Anthem Blue Cross PPO plans in regions 1 through 9 and 15 through 19 in 2016 are impacted by this change.

What if I don’t do anything?

If you take no action to renew or change plans through Covered California, your coverage will automatically be renewed 30 days after the date on the Covered California renewal notice, into the Anthem Blue Cross EPO plan available in your area. If you want to make a change to your plan for coverage beginning January 1, 2017, a new plan must be selected by December 15, 2016.

What difference does it make, PPO or EPO?

PPO plans are the most desirable because they offer out-of-network coverage. However, they tend to be more expensive and sometimes people don’t use the out-of-network coverage enough to make it worthwhile. On a PPO, your out-of-network expenses are discounted, but you will always save money by staying in-network. For more information see PPO vs HMO.

EPO’s do not offer out-of-network coverage, and thus are less expensive. Since Anthem rates are rising an average of 17%,  and for some as high as up to 36%, many Californian’s are looking for price breaks anywhere they can get them. So switching to an EPO may help.

What if I want to stay on a PPO?

If you are on an Anthem PPO plan that is going to be discontinued and you want to keep PPO coverage, then you’ll need to switch to a Blue Shield Covered California, if available in your area.