Blue Cross Blue Sheild of Texas. Group Health, Individual and Medicare Supplement Insurance.
At De Leon Enterprises we've got you covered with the Best. www.deleonenterprisesinc.com

Blue cross and blue shield of texas

WHO WE ARE

Blue Cross and Blue Shield of Texas knows health care coverage in Texas — we invented it. We're Texas born and bred, and this is the only place we do business.

We have been around for more than 80 years, and the cross and shield have come to represent the most experienced health care coverage organization in the state and the nation. Our mission is still focused on providing financially sound health care coverage to as many Texans as possible.

As the state's largest health insurer, we serve some of the best-known Texas companies, including American Airlines, Brinker International, Brookshire Grocery, Halliburton, H.E.B. Grocery, JBS, Southern Methodist University (SMU), the Texas A&M System, Texas Instruments, Texas Medical Association and The University of Texas System.

We maintain our state headquarters in Richardson, with regional offices in Houston, Austin, and Lubbock. In addition, we process our members' claims in Texas in our claims and customer service facilities in Abilene, Marshall, Richardson, San Angelo, Waco and Wichita Falls.

We're a statewide customer-owned health insurer in Texas. We believe Texas consumers and employers deserve the best of both worlds — access to affordable, quality health care and top-notch service from a company that focuses solely on customers, not shareholders. Customer value is our cornerstone.

We grew up in local Texas communities, and we've stayed there. However, our significant local presence throughout the state is just one reason why the cross and shield create peace of mind when it comes to choosing health insurance. Here are a few other reasons:

• We have a special relationship with physicians and hospitals dating back to 1929. We remain committed to partnering with physicians and hospitals to provide access to affordable, quality health care, and we are a collaborative partner seeking solutions to joint concerns with employers, physicians, hospitals and governmental bodies.
• Our health maintenance organization (HMO) and preferred provider organization (PPO) networks are large. For example, the HMO Blue Texas network includes more than 451 hospitals and 38,000 providers statewide (Source: Internal PREMIER Reports, July 2009).
• In addition to providing broad access to affordable care, we have a commitment to member empowerment in personal health and wellness.
• We administer the state's Texas Health Insurance Pool, which provides health insurance to eligible Texas residents who, due to medical conditions are unable to obtain coverage from commercial insurers (Source: Texas Health Insurance Pool website).
• Since 1997, our statewide Care Van Program has given more than 712,522 free immunizations/screenings to over 428,890 uninsured Texas children through November 2009. (Source: Internal Care Van Program Activity Report, November 2007).

As a division of Health Care Service Corporation (HCSC), Blue Cross and Blue Shield of Texas is among the financially strongest health insurers in the nation, providing our members with a high level of confidence and security. For detailed financial reports, please visit the HCSC website.

Whatever you needs please visit us and www.deleonenterprisesinc.com or www.seniorshealthllc.com and we'll be happy to answer any questions you might have.

We're proud to promote the Blue Cross and Blue Shield of Texas. 

The truth is Medicare Advantage only works well when you are healthy but when you get sick they leave turn their backs on you and say...good bye! There are no restrictions on these insurance companies when they do it either. 

Thank Brad Wright for sharing this information. It's what we have been telling clients for years.

We all know about Medicare, the federal government health insurance program for Americans who are over the age of 65 and/or disabled. We know that as we have begun to live longer, the Medicare population has ballooned and the costs of the program are, by most estimates, “unsustainable.”

We also know that Medicare, despite being a government program, is beloved by America’s seniors. If it was an unpopular program, Congress would have cut it long ago, saved billions of dollars, and we wouldn’t be talking about debt ceilings. But, the fact is that the Medicare program is extremely popular, making any proposed changes to it–even changes deemed necessary to preserve the program–a political liability. That is why both Republicans and Democrats have blamed each other for wanting to cut the program. They know that if they can pass the blame effectively, it would be the kiss of death for their opponent.

But, while we know all of this, what far fewer of us know about is a special offshoot of the federal Medicare program–a privately administered model known as Medicare Advantage. In 1997, the passage of the Balanced Budget Act created what were known as Medicare+Choice plans. By 2003, when the Medicare Prescription Drug, Improvement, and Modernization Act was passed, Medicare+Choice was re-branded as Medicare Advantage. These Medicare Advantage plans work differently than traditional fee-for-service Medicare. Let me explain.

Under traditional Medicare, at the time they become eligible, individuals receive hospital coverage (Part A), which they have paid into during their working life (or that of their spouse), and they may pay a relatively low monthly premium to receive physician coverage (Part B). While these beneficiaries have to pay certain deductibles and co-insurance, the Medicare program generally covers all necessary health care services.

By contrast, Medicare Advantage works on a more capitated model. That is, the federal government pays private insurers who offer a Medicare Advantage plan a fixed dollar amount per member per month. Beneficiaries still have to pay their monthly Part B premium to Medicare, but they typically do not pay additional premiums, and they usually pay a co-payment at the time of a health care visit, rather than a deductible and coinsurance. To top it all off, Medicare Advantage plans have to provide coverage that is as good as traditional Medicare, but they can also offer additional benefits, and most plans do offer things like vision and hearing benefits, and even gym memberships.

On the surface, these Medicare Advantage plans certainly seem advantageous. After all, who doesn’t prefer lower out-of-pocket costs and more benefits? This likely explains the growth in Medicare Advantage enrollment from 5.4 million beneficiaries in 2005 to 11.1 million in 2010. But there’s a catch. You read it, but maybe you glossed over it. Let me draw your attention to it again: “the federal government pays private insurers who offer a Medicare Advantage plan a fixed dollar amount per member per month.”

If you’re running a business and trying to make a profit, and your model is based on receiving a fixed monthly payment for the individual, paying a significant portion of the costs of their care, and pocketing the difference, what are your incentives? If you answered, “To pay as little for their care as possible,” you’re on the right track. But they can’t do this by denying benefits to those of their enrollees who use the most care. What they can do, is work diligently to target only healthy people to enroll in their Medicare Advantage plan. The strategy is simple: By selecting healthy individuals who will use less health care, they keep their costs down and generate larger profit margins. Meanwhile, traditional Medicare gets left caring for the sickest subset of the elderly and disabled population.

Recent research, which Jordan Raul of Kaiser Health News summarizes nicely, confirms that this is precisely what is happening. The bottom line is this: Medicare Advantage works to your advantage when you are healthy, but if you happen to get sick, the private insurance market will turn its back on you, and traditional Medicare will be there to greet you with open arms–provided we can keep it solvent. So, the next time you hear Politicians say they want to privatize Medicare, it might sound like an attractive option right now, but think long and hard about what it would mean if you actually got sick and needed insurance on which you could depend. If your turning 65 or would like to learn more about your options. If you're in the Houston area or surrounding counties and are turning 65 or would like more information please contact us. www.seniorshealthllc.com