Bad News for Blue Shield PPO Members in 2016

Posted: September 16, 2015

by Stephen Saucier

One strength of Blue Shield’s PPO plans has been the fact that they have only one deductible rate regardless of in or out of network charges. For example, in 2015 the deductible for the Blue Shield Silver 73 PPO was $1,600 for individuals and $3,200 for families. These rates held true regardless of whether you receive coverage from in-network providers or out-of-network providers.

Starting on January 1st of 2016, Blue Shield will be implementing a change that effectively adds a new out-of-network deductible. Next year the in-network deductible for the Blue Shield 73 PPO will be $1,900 for individuals and $3,800 for families. This by itself would be bad news considering the $300 and $600 price increase respectively. But that’s not all; there will also be an out-of-network deductible of $3,800 for individuals and $7,600 for families. These 2 deductibles exist separate from one another. That is, meeting the in-network deductible doesn’t have any effect on you out-of-network deductible and vice versa.

I view this as a major step backwards in plan coverage. What was once a major strength of Blue Shield PPO’s has become a weakness. Indeed, an unfortunate change for Blue Shield PPO members.