September 12, 2025 • 36 mins
Barron Roberts is my expert today on this Blue Cross Blue Shield Kansas City update show. How will it play out for all of you out there in the audience for your coverage in '26? We will cover the individual side and what Blue Cross is doing to lead the way. They're actually going to have premium reductions on the individual side, and we'll talk about what are the answers to the employers out there, the small group employer, the employer under the 100 lives.
Get all the details and find the best way to go now, because come January 1st, all the Aetna plans are pulling the pin on ACA. They're going to be gone. And I will cover what's going to happen with the other plans. They're going to be significant increases across the board. BlueKC continues to lead the way as the local hometown carrier.
This is Ep2127 of America's Healthcare Advocate.
Learn more at https://www.bluekc.com/ or call 833-467-2145.
As always, if you need help or have something to share contact me with this form on my website and let me know what's on your mind, issues you are dealing with, or other health, healthcare, and health insurance questions and concerns. Visit: https://www.americashealthcareadvocate.com/contact-us
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
And now America's Healthcare Advocate,Cary Hall.
Hello, America.
Welcome to America's Healthcare Advocate.
Show broadcasting coastto coast across USA.
Here on the HIA Radio Network, you canlearn more about us going to our website.
AmericasHealthcareAdvocate.com.
Also your favorite podcastplatform, SoundCloud, whatever it may be.
(00:22):
Spotify, Rumble, all of them.
We're on 16 of them and our YouTubechannel, America's Healthcare Advocate.
My producer today, Mr.
Dave Thiessen, behind the cameras,
doing what he always does,bringing all these shows together.
They go up on our podcast platformsand our YouTube platform.
And Garner Cowdrey,who is behind the microphones here
in our beautiful Cumulus Studios.
(00:44):
If you need help,if you are, chronologically challenged
or you are looking for individual ACA,the lovely Carolee
Steele at RPS Benefitsby Design, will be happy to help you.
You can reach her at 877-385-2224.
And if you're looking for employersponsored
health insurance,Maria Ahlers is also happy to help you.
They have access to all the great plansout there, including those brand new
(01:08):
Blue Cross and Blue Shieldplans are going to roll out this year.
And so in studio with me, Mr.
Barron Roberts from Blue Cross and BlueShield of Kansas City. Welcome.
Thanks, Cary.
I haven't done a show like this,I think in probably six years.
And now I'm going to tell you whyI just said that.
So here's what's going on in the ACA
marketplace that I warned youthis was going to happen some months ago.
(01:31):
This is this is what we're looking atwith carriers.
Celtic Insuranceincreased this year 24.4%,
Medica 29.2%.
UnitedHealth Insurance 10.7%.
You want to tell us what the Blue Cross
and Blue Shieldincrease is going to be this year? Yeah.
So in in Kansas we're looking at a -4.1%.
(01:52):
And in Missouri a negative six.
Did you hear what I just said.
I reversed that Cary.
That's all right. Yeah that's all right.
The point is they’reactually going to be a premium reduction.
Now the last time I did a radio broadcastwhere there was a decrease in premiums
was Ron Rowe, about eight years ago,if I remember correctly.
So it's been a while. All right.
(02:12):
And this is a great piece of newsfor everybody in the Kansas City metro.
So I'm going to repeat that.
So they're looking at Missouri at a -4.4%.
And in Kansas a -6.1%.
So there must have been a lot of workwent into this.
If you're bucking the whole marketplace,
okay, all the national carriers, etc.,
(02:35):
and you're coming in at numbersthat are good,
and then we're going to talk about
some of the specific plansyou're going to offer.
They're going to be very different.
But how did you guys get to this.
Yeah we put a lot of workdesigning these new plans.
We gathered member feedbackfrom across the community.
We gathered our broker partner feedback,
months and
months ago to put together plansthat would fit,
(02:57):
the members of our community.
You know, it,
when we talk about the independentBlue Cross plans, like Blue
Cross of Kansas, Blue Cross of Nebraska,Blue Cross of Kansas City.
You know, there's the taglinethat always comes to mind for me
when I look at that versusthe big carriers.
The big Aetna’s,the big UnitedHealthcare's.
(03:18):
the Cygnus, and that is we're Main Street,not Wall Street.
And you're right down here on Main Street.
You know, you serve this market.
You've been herefor how many years? Over 85 Years.
85 years in Kansas City.
And you're able to come to the peoplein this city and say,
we're going to cut premiums this yearby 4.4% Missouri and 6% in Kansas.
That's pretty significant. Absolutely.
(03:40):
There's a lot going on in the ACAthis year.
You know, there's enhanced subsidiesthat are going away or expected to go away
at the end of the year unless there'ssomething that changes about that.
You'll have a $5, additional premium
applied to your billif you don't go in and update your income.
It's a very active open enrollmentthis year.
And we would encourage everyoneto go out and review their details
(04:03):
within their marketplace accountto ensure that they are getting,
assessed the right premium for one,but also evaluate their options.
And as you mentioned,we're giving decreases this year.
We're going to be much more competitive.
Well, you’regoing to be much more competitive.
And there's a tsunami coming.
I've been telling people thisfor the last four months.
Okay. I've done multiple shows on this.
(04:24):
There's a tsunami coming that, no longerare you going to be able to self affirm.
You're actually going to have to,
you know, have documentationthat says you made ‘X’.
The automatically renewingsubsidies are going from 400%
of the poverty level back to 150 to 200,which is where they were
before we had the expansion in 2021.
Well, that's going away now.
(04:45):
So there's going to be massive marketdisruption in the marketplace.
Between 90 and 93% of Americans
today on the ACA,have the enhanced subsidies.
So 90 to 93% are going to be affectedby these changes.
That's huge.
All right.
And so what BlueCross has done isthey've stepped up to the plate
and said, we're going to buck the markettrend.
(05:08):
You guys are taking a risk here.
There's no guarantee.
You know this is going to work outfor you guys in a year from now.
You're not going to be going, oh, Lord,you know, but the fact that you're willing
to make that commitment to this communityafter 80 years of serving
this community says a lot about Blue Crossand Blue Shield of Kansas City.
You know, most certainly.
And we've done a lot of things toto get there.
(05:29):
What we're looking at different caremanagement programs.
In addition to that, we're rolling outa brand new network in 2026.
Will help us get to the pricing pointthat, members are looking for.
Yeah.
And that new network
you’re going to have,
we'll talk about that when we get intothe next segment of the show.
And then obviously, Spira Careand how that's going to fit into
(05:49):
the equation is really interestingbecause we're seeing a lot of initiatives
now for, primary care,direct primary care,
getting away from the hospital models,the other models,
which is kind of funny because how longSpira Care have been in existence.
Yeah, since 2018. Okay.
So I mean youthe compliment Danette Wilson.
Okay.
For having,
(06:09):
you know, the vision to say we'regoing to do something really different.
I remember when everybody was like,this is never going to work.
Well here we are in 2026.
And guess what.
Not only is it working, it's workingphenomenally well.
Yeah. Very well.
Our members are reporting,96% customer effort
(06:30):
score at Spira Care,which is a true testament
to the experiencethat they get there, the accessibility,
and and being able to get to a providerthat, keeps costs low.
Let's give folks the dates when they canwhen this is all going to start with OEPs.
For ACA, you'll have a shopping periodor shopping window towards the tail
end of October,so you can go out and see what
(06:52):
the different prices and plansthat are available.
And then open enrollment startsNovember 1st
up until December15th for a 1/1 effective date.
And then if you're enrollingfor a 2/1 effective date,
that enrollment can come in after December15th up to January 15th.
And that's it.
That's it.
Okay.
So here's my admonitionto all of you out there in the audience.
(07:15):
All you folks like to procrastinate.
This is one yearwhere you better not procrastinate.
Okay.
You know, I'mgoing to give you the phone number,
and I'm going to suggest youthat you probably you ought to start
making some calls and start talkingto people and get ahead of this thing.
So you can call the folks down at BlueCross.
They can they can chat with you.
They can set up a time to talk to youafter OEP, whatever you want to do.
(07:38):
But you need to get ahead of thisbecause once this tsunami hits,
you guys are going to get buried.
You're the only plan in townthat’s offering decrease,
you're going to get hammered.
We're going to get a lot of calls.For sure. Yes, you are.
And there's going to be a lotthat has to happen here.
So the phone number is 833-467-2145.
833-467-2145.
(08:00):
And the website is bluekc.com. Yes. Yep.
All right.
So if you want informationyou can go up to the website.
But I would strongly suggest
you start making arrangementsto have these conversations now.
So you're not caught at the last minute.
Because as I saidit's going to be a tsunami.
There are a lot of changes coming.
A lot of folks are going to be affectedby these changes.
We come back to the break.
(08:21):
We'll talk some more about thisand how and the new plans
and the new networkand all that they’re doing,
and then we'll switch gearswhen we get to the third segment,
and we'll start talking aboutwhat's going to happen
to the small employer,because small employers on ACA
type plans are also going to get hitwith very significant increases.
What is Blue Cross doing to address that,and how are they addressing that
(08:41):
so they can help the small employerin the marketplace?
Stay tuned.
We'll be right back after the break.
You're listening to America'sHealthcare Advocate
Broadcasting here on the HIARadio Network.
Coast to coast across USA. We've got more.
Stay right there.
That phone number once again.
833-467-2145.
Stay right there. We'll beright back after the break.
(09:12):
Welcome back.
You're listening to America's HealthcareAdvocate show, broadcasting coast
to coast across the USA here on the HIARadio Network.
Once again, you can find out
more about us by going to the websiteAmericasHealthcareAdvocate.com.
You have an email.You want to send me a note?
Please do so.
Go to the website. I'm happy to help you.Any way I can.
I want a shout out to WNRP, AM 1620
(09:35):
and FM 95.3 Pensacola, Florida.
Happy to have those folks on boardas part of America's Healthcare Advocate
family broadcasting down thereevery Saturday at 8:00 in the morning.
And we love Pensacola, Florida,by the way.
So, all right, let's switch gears now.
And we kind of gave peoplea little tease there.
This new plan, which I'm hearing a lot.
(09:57):
In fact, we just had the folks
from RPS Benefits by Design up here,and they were talking about it.
And you guys have had a big brokermeeting the other day,
and there's some pretty excited brokersout there to learn about this new plan
that's coming in play,and what a difference
it's going to make people.So let's talk about it. Yeah.
What's it going to be called. Yep.
It is going to be calledthe Simply Blue Plan.
Simply Blue. All right.
(10:19):
And we'll
actually have three onein each metallic category.
So gold, silver and bronze.
We're pretty excited about it.
At the
smaller rollouts that we've done so far,brokers are getting excited about it.
We had a group up here this morning.It's pretty excited about it.
Yeah.
So, the price point on that,that will be our lowest price plan
that we have available.
(10:40):
It'll be offered in the Johnson County,Wyandotte County and Jackson County
metro area. Okay.
And it'll be a partof what we call the Blue Metro Network.
Okay.
That'll consist of Saint Joseph,
Saint Mary's UniversityHealth and Providence.
And it also includes UniversityHealth Lakewood as well.
Lakewood and then downtown.
(11:02):
Yep. Okay.
Then ProvidenceHospital over in Kansas City, Kansas.
That was the other one.
Saint Mary's down south. In Blue Spring.
and Saint Joseph.
So it’s a narrow network.
But the price point is going to be.
Much better.
You know what people are goingto have to do is be willing
to accept a narrower networkin order to get that price point.
(11:24):
The good news is you're giving theman option.
Absolutely.
They're not going to seewith the other carriers so
you're addressing the issueby getting creative
and giving them an optionso that somebody,
you know, if they do lose their subsidyand they need coverage,
at least they can keepthey can still stay in Blue Cross. The.
(11:44):
Whole nine yards.
Okay.
Now is Spira Careaccessible on those plans.
So each one of those plans will haveaccess to all nine Spira Care centers.
That's huge. Yeah. All right.
So now you just took primarycare out of the equation
from the standpointdid they have to drive to a facility.
They've got one of the nineSpira Care centers.
So you're connecting the two now.
(12:05):
So all of their primary care,behavioral health,
all the other things that go withthat will be in Spira Care.
Yeah, they'll have access to that.
And, access to Spira Care is much fasterthan a traditional primary care.
23 days to a typical wait to get into see a primary care doctor.
Then you get 7.5 minutes.
(12:26):
That's the average timeyou get with your primary care.
Little different. In Spira Care.
Talk about. That. Yeah, yeah.So in Spira Care.
You can get inand get your original orientation
visit set up much earlierthan traditional PCP office visits.
And then on top of that for sick careor a little bit more urgent type care.
You can get in to see Spira
within a few days, if not the same day,depending on the circumstance.
(12:49):
To me, when you're balancingthat narrow network piece
for cost effectivenessand but you're not saying to them, well,
you're going to go find a new primary careprovider.
No, you can come to Spira Careand we'll take care of you here.
We've got nine clinicsaround the Kansas City metro,
so you're giving them an option wherethey've got primary care, taken care of.
(13:11):
Whatever they need is right there.
If they need major medical,they can go to one of the hospitals
and get major medical.
Absolutely.
And hit on one more thing there Cary.
Care at SpiraCare is at no cost to members.
So they've got easy access,affordable access.
They'll have a great experiencethere and care is at no cost for Spira
Care members. Yeah.
So there's yourthere's your key takeaways right there.
(13:32):
And you heard him say in the last segment,96% of the people coming away
from Spira Care are telling themthey're doing a good job.
All right. So if you're not going to
make co-pays.
You're not going to have to payout-of-pocket costs for this.
When you think about marryingthat up with the plan, it's
going to save youa significant amount of money.
That sounds like a pretty winwin deal to me.
(13:54):
Yeah, absolutely.
That is, taking total cost of care downfor members and families for sure.
So rolls out. Win.
This will roll out,January 1st is a new product.
Open enrollment starts 11/1.
Great. Startlooking for that plan starting 11/1.
And if they want to call
and just have a consultation with somebodyand talk about that plan,
they don't have to wait to open enrollmentto make a phone call to say
(14:16):
this isn't Medicare. Right? Okay. Right.
Yeah.
Where we got the thought police out theregoing, you can't call it.
You can't talk to anybody. Yep. They can.So this is a different deal.
This is ACA.So they can call anytime they want.
If they've heard about this planit's called Simply Blue.
That's pretty easy right. Simply Blue.
And there are three plans.
There's there's the there's the gold.
(14:38):
There's the silver and there's the bronze.
So you've got three separate plansto offer.
I assume there's going to have differentdeductibles. Correct.
2000, 4000 and 6000.
And the premiumsall vary depending on the plan. Okay.
So if you know, if you'reif you're one of those folks
that's chronologically challenged,you're in your 50s,
you probably don't need a $2,000deductible
(14:59):
because you’re not running to the E.R.,the urgent care and all the other things
you're going to have to dowith the household children.
So you could go to a $5,000 deductible.
Can that be tied to an HSA?
So actually new for 2026,
bronze and catastrophic planswill be eligible for HSA, compatibility.
Okay. So that's huge. Yeah.
(15:20):
And the thing about the HSAis that I always try to get people's
headsis it money going in is tax deductible.
So you made 100 grand.You're going to pay taxes on 100 grand.
No you're not.
You're going to take 6300 off that.
It’s your moneyyou're putting into your account.
Oh and by the way, when you take it outit's tax free.
So if you went to the higherdeductible plan
and you had to gohave a surgical procedure,
(15:42):
you've already got your deductible thereto pay to get it done.
Correct.
And if you don't use it,you don't lose it.
Unlike,Like an HRA or something like that.
All right.
This plan is not a flex. It's not an HRA.
This money rolls over every year.
So you can continue to add to itSo if you put all those pieces together
you got some answers here. Absolutely.
(16:03):
And that's that's really kind ofwhat BlueCross
Kansas City has always been known for
is that you have the answersand you're serving this community.
And this is a great opportunity.
You know, once again,they're called Simply Blue.
I strongly suggestthat you are the up on the website, yet.
No. They won't be up on the websiteuntil late October.
Okay, so. During the shopping seasonin. October, you can go up there.
(16:24):
They'll be up thereif you just want to call
and have a conversation with himabout this, you can do that.
833-467-2145.
833-467-2145.
By the way, there are 1 millionpeople out there across the country
that are losing their coveragebecause Aetna’s pulling out of the market.
You folks probablyought to be the ones on the phones first.
(16:45):
Okay.
And looking for these plansand to see what they can do because,
come January 1st, all the Aetna plansare pulling the pin on ACA.
They're going to be gone.
And I and I read to you earlier what'sgoing to happen with the other plans.
They're going to be significant increasesacross the board.
BlueKC continues to lead the wayas the local hometown carrier.
We'll be right back after the break.
(17:05):
You're listening to America'sHealthcare Advocate broadcasting
here on the HIARadio Network coast to coast across USA.
Stay rightthere. We've got more in the next segment.
(17:25):
Welcome back.
You're listening to America'sHealthcare Advocate show broadcasting
coast to coast across USA here on the HIARadio Network.
My producer behind the microphones, Mr.
Garner Cowdery behind the cameras,
putting all these shows togetheras he does every week.
Dave Thiessen
in studio with me, Barron Roberts, BlueKCwe're talking about the coming tsunami
That's what's going to happen,both on the individual side
(17:48):
and on the group sidewith anything associated with ACA.
And how is that going to play outfor all of you out there in the audience?
So we've talked about
on the individual side and what Blue Crossis doing to lead the way.
They're actually going to havepremium reductions on the individual side.
Right now we're going to switch gearshere, and talk about
what are the answers to the employersout there, the small group
(18:09):
employer,the employer under the 100 lives.
What are the answers to them?
What is Blue Crossdoing to address the issues
that they're going to deal with?
Because that's going to happen.
All right.
And if you're you know,you need to talk to your broker.
If you don't talk to your broker, callthe folks at Blue Cross and Blue Shield
at 833-467-2145.
(18:30):
If you want to have a conversation beforeyou get to the point where you've got
the renewal, now you're looking at a 20%increase that came from another carrier.
you might want to give them a calland have a chat.
All right. Let's talkabout what you're going to do.
Alright,
how are you addressing this marketand what are you doing to help employers
deal with these issuesand the brokers out there that are
(18:51):
the ones representing your products?
Yeah, absolutely. Gary.
So we put a lot of work into the 2026plan designs for small group.
Number one.
We went out and surveyed
our broker community and asked them,what are employers asking for?
We took those notes.
We took, feedback from our team,and we developed new plan designs
for 2026, to help reduce the overall,
(19:15):
premiums on the baseline for employers.
And you're confidentthis year's new rollouts,
what are they going to look like?
You know, we've already had a coupleof smaller rollouts, our broker community
and our brokers that we've presented
in front of our pretty excitedabout these changes.
We've got updates to Blue SelectPlus eligibility, more members,
(19:35):
will become eligible
to enroll in Blue Select Plus, Blue SelectPlus has Spira Care.
We have brand new plan options.
Some of them have higherdeductibles, new plan designs.
Some of them have no deductibleon medical, whatsoever with fixed co-pays.
So that's going to open upa lot of opportunity there.
Run that by me one more time.
No deductible on medical.
(19:56):
And so we’ll have just co-pays on primarycare office visits, specialist visits.
And some of those planshave just co-pays on inpatient as well.
That's going to be remarkable.
Yeah.
That's going to be that goingto be a game changer for people.
Let's go back to Blue SelectPlus you talked about some things.
So what are some of the thingsgoing to happen there. Yeah.
So for Blue Select Plus, for many yearsnow we've been getting questions
(20:18):
and really requests to expandour Blue Select Plus eligibility.
Right.
So you know members that live in MiamiCounty or right outside Johnson County,
right outside Wyandotte County,
we have employer groupsthat are within those counties
today that have membersthat live just across the county.
Line, right.
(20:39):
That have not previously been eligiblefor Blue Select Plus or Blue Select
Plus with Spira Care. Right.
And so starting in 2026,we're actually opening up some eligibility
there and allowing those membersto enroll in Blue Select Plus and Spira.
Wow. Yeah.
So I think they're going to be excited.
Those members that live in those countieswill have, new plan options.
(21:00):
The Spira Care experienceif they enroll in the Spira Care plan.
And those employers may be a little bitmore open to offering,
that plan option as well.
Yeah.
And the beauty of that is we talked aboutSpira Care in the last segment.
We’ll touch on it againa little bit because the beauty of that
is that the employer can say herewe're going to go to a higher deductible,
but all of your primary care,behavioral health, X-rays,
(21:24):
labs, all that is going to be handledby Spira Care.
All right.
And if you need to be referred out,they'll take care of doing that.
So you're taking away the biggest obstacleto care that people have.
That is I can't afford a $50 copay, okay.
Or a $75 copay to go to a specialist.
Okay.
But I can go to Spira Careand I don't have to pay anything.
(21:45):
So now you're marrying that to this plan,which keeps affordability in line
and also says to the employee,my employer really does care
because they put this plan in placeso that I can go to Spira Care,
not just the employee,but the employees family as well
up there on the plan, right? Right.
and when you think about total cost ofcare savings, if you got a family of four
(22:06):
of going to the providerevery year on top of reduced
premium, you're going to savea significant amount of money.
Yeah.And you know, I've got six grandchildren.
And I can assure you that my two daughterswith those six children,
there is not a week goes by that there isnot a visit at the urgent care, the E.R.
or some specialist doctorthat they've got to go to
(22:28):
because there's a new issuewe've got to deal with.
Okay.
So for families, to me, this just seemsto make an awful lot of sense.
Yep. And those care centers also offer,
servicesthat support pediatric care as well.
So if there's younger children there,they can help them as well.
Yeah. So we've got nine locationsaround the metro.
(22:49):
Where are. They?
Yeah, absolutely. Cary.
So, Tiffany, Liberty,Legends, Shawnee, Olathe,
Overland Park,Independence, Lee's Summit and Crossroads.
Well, you've got onealmost everywhere in the city.
All over the city.Nine locations for Spira Care.
Anywhere in the cityyou have access to Spira Care.
So in other words,there's some places close to you.
(23:10):
Yeah. Okay.
You're not going to have to drive 45minutes to an hour to get to a facility.
Right.
And the whole the whole conceptof putting the Spira Care’s
all around the Kansas City community,if you look there, really circled
all within the 435 interstate.
So any member within the Kansas Citycommunity
should be able to get to a Spira Carewithin 10 to 15 minutes.
(23:30):
And this is the solution.
That as an employer,you really need to take a look at.
If you want to keep your employees happy,give them a benefit that’s going to mean
something to them and, give them accessto the kind of care they need.
This is an opportunity to do that.
Talk a little bit
before we go to break about levelfunded, fully insured in the ACA.
(23:51):
Our Level Funded, option for 5 to 99
size employers, 5 to 9 enrolled employees.
That optionis available for the small groups.
A lot of groups are finding those optionsto be
you know, a great product,an affordable product.
It is a very attractiveand growing market in that space.
(24:14):
For ACA, that's 2 to 50.
2 to 50 enrolled employees.
And then for fully insured, underwritten,it's 51 to 99 enrolled employees.
So explain that because that that.
I'm an employer now I've got 75 employees.
So if I want to move to it and I andmy workforce is trending below 45.
(24:35):
So now I know that you know thatif they're trending
below 45, they're going to be a healthierbunch, right?
They ought to be.
We'll make an assumptionthat they're reasonably healthy.
Okay.
So having said that,when they go to that model,
they're going to be judged on that groupas a group, not being judged
(24:55):
on this giant pool of people over here
with ACA, a lot of sick peopleand other people on it.
It gives them an opportunity
if they've got a pretty healthy group or
groupthat doesn't have a lot of major issues
where they can actually puta program together,
that really is kind of tailoredto what they need, correct? Yep.
And in addition to all the plannedchanges, the new plans we have coming out,
we've also opened upour underwriting guidelines Cary.
(25:18):
Oh really? In addition to. That.
Well, that's a big deal.It is a huge deal.
Yeah okay.
So explain what that meansbecause I'm sure the audience out there
what does that mean.They opened up their underwriting.
Yeah.
So, we're making it easierfor employer groups to apply for coverage.
Those that have at least tenor more enrolled employees on the plan.
And so what I mean by that is we need a
(25:40):
we need a group census with at least tenor more enrolled on the plan.
We need that group app.
And we need a couple of other piecesof information and we can turn around
and quote that group on, level fundedor fully insured?
51 and 99.You know, that's pretty amazing.
You've got a suite of products here.
Yeah. I'm kind of talking to the brokeraudience now a little bit.
(26:02):
You've got a suite of products herethat are addressing
concerns in the marketplace,and I'm not seeing this anywhere else.
I'm not seeing it from the other carriersout there.
I'm seeing carrierspull out of the marketplace,
and I'm seeing articles in the Wall StreetJournal, other places talking about
how difficult it's going to be for themto continue this year.
But you're seeing something completelydifferent here by the hometown carrier.
(26:24):
And if you're the broker out there,you really need to engage in this.
If you haven't gottento one of their seminars, the webinars
to learn about these products, you need tobecause you're going to be getting calls
from your clients,who are going to hear this show
and the commercials run during the weekwhere we talk about these kind of things.
They're going to ask you,
why haven’t you been telling me about thatnew Blue Cross plan?
(26:46):
Okay.
Because they're going to be a host of newBlue Cross plans.
They're going to address,
what'sgoing to happen in this marketplace.
And I'll repeat what I said earlier.
We're going to see a tsunami in changesthis year on the ACA.
Small group side across the board.
Impactedby all the changes that are happening.
And it's importantfor you to get ahead of that.
833-467-2145 if you're an employer, okay?
(27:10):
And you just want to have a conversation,they're happy to do it.
833-467-2145
or the website bluekc.com, bluekc.com.
We'll be right backafter the break to wrap it up, stay tuned.
You're listening to America'sHealthcare Advocate
broadcasting here on the HIARadio Network.
Coast to coast across the USA.
Don't go anywhere.
(27:37):
Welcome back.
You're listening to America's HealthcareAdvocate show, broadcasting coast to coast
across the USA here on the HIARadio Network.
You know,
I do these shows to get informationout to all of you
aboutwhat's going to happen in the marketplace.
I got I have BlueKC up here todayto tell us what they're doing
to address the concerns that people aregoing to have as we get closer to renewal
(27:59):
on the individual side and on the employersponsored health care side.
They've got answers.
They've been here for 83 years, okay?
They've got answers.They're the hometown carrier.
They're the only carrier in this marketthat's actually reducing premiums
on the individual side.
So again, if you're a brokeror if you're an employer or an individual
and you want information833-467-2145 is the phone number.
(28:24):
They're happy to talk to youand get you set up for
what's going to come down the pikethis year 833-467-2145.
And the website bluekc.com.
All right, let's go back to SpiraCare a little bit
because this is such a unique valueproposition.
Now, and, you know, it's funny,you don't have to wait
23 days to get in to see a doctor. Yeah.
(28:45):
And the visit is probably goingto last longer than 7.5 minutes.
Right.
I know the average visit with SpiraCare is about 30 minutes.
Okay.But it's it's a very different care model.
So talk a little bit about that
and why that is really something bothemployers individuals should consider. So
you know starting off with just the SpiraCare story, we rolled it out in 2018.
Over time, we've added more care centersacross the Kansas City community.
(29:09):
We're up to nine so far.
With that,
the idea was to ensure that every memberwithin Kansas City
could have access to Spira Care easilyand relatively close.
So each membercan get to a Spira Care center
within 10 to 15 minutes at least,that was the design that we had in mind.
And it worked.
Yeah, yeah.
(29:29):
Members are you know, reportinga great experience there.
We grade ourselves on the customer effortscore of our members
not only the Blue Cross members,but also our Spira Care members.
And for the those Spira Care members,
the customer effort score is 96%.
And just to put it in perspective,
you know, gold plans,
(29:50):
industry best is right around 72%.
So holy cow.
Are you serious? We're getting great.
Great feedback from members on theexperience that they have at Spira Care.
And have you got the capacity to handlewhat's going to be coming down the pike?
Because I got a funny feeling, pal.
Your phones are going to be ringing.Yeah, yeah.
We do.
Each of our care centers have capacityto continue to grow and grow membership.
(30:14):
Some of the newer oneshave even additional capacity
to have additional rooms in therethat they can add on.
So, we're pretty confident our, the growthopportunities we have ahead for 2026.
So there is one component about Spira Carethat I always thought was unique
because nobody else does this.
I mean, there are there are other modelsout there for direct primary care.
But your behavioral health, I mean,this is a big deal to Erin it's a big deal
(30:37):
to Jenny, you know, Christina Lively,all the C-suite people at Blue Cross.
Talk a little bit about thatand the fact that,
you know, it's right there in the center.
You don't get referred outto go see somebody outside.
You can start right therein behavioral health.
And to me, this is important,especially for people with kids these days
(30:57):
that are dealing with issues,whether it's, you know, cyber bullying
or what's going on at schoolor just some of the talk a little bit
about that whole behavioral health pieceand how that fits.
Because I think that separatesSpira Care from everything else out there.
Yeah, yeah.
So, as you mentioned,it's very important at BlueKC
you know, our leadership team,all of our all of our team members,
(31:18):
to provide accessto behavioral health services,
not only at Spira Care,but also through all of our apps
and all of our resources and mindful,we've got a ton of resources available.
But at Spira Care,we did integrate behavioral health care,
to ensurethat members had access to that service.
And there is screenings that occur withinthe Spira Care centers to help understand
(31:40):
if members need that type of careand we help get them there.
Yeah.
And, you know, for the mother,you know, that’s
got 2 or 3 children and she's got onethat's having a problem.
She doesn't have to worry about goingsomeplace else.
She can go to Spira Care
and that child can be privately counseled,whatever they need to do.
And the whole thing workslike it's supposed to.
(32:01):
Yeah.
So, in addition to that,there's no cost at Spira Care.
Well, that's that's a big piece, right?
Yeah, yeah, it's the,you know, all the co-pays are gone.
So, you know, that's criticalto talk about some of the other services
that Spira Care offers.
You I know labs and X-rays are availablein certain facilities.
How are you handling prescription drugs.
The rest of it.
Yeah.
So, each of our Spira Care planshave, prescription drug,
(32:25):
model plansthat enable, low cost for prescriptions.
So tier one and tier two are co-pays,and then tier three,
typically havea level of coinsurance. But,
the Spira Care centers will refer out
those prescription drug needs to,local pharmacies that are in network
so members can get accessto those prescriptions.
(32:46):
So that's all part of the plan.
They don't have to go dealwith another plan or some other issue.
That's all going to be handledthrough the Spira Care facility.
It's all built in.
Okay.
That that that's pretty significantin terms of how that works.
Are you doing anything with urgent careafter hours visits?
Yeah.
So some of the care centers
have not only they have after hoursvisits,
but some of them are openon the weekends as well in case.
(33:07):
That's new because that. Yeah.
Okay. That's that's.
Yeah.
So it's, you know, you have to calland make sure, you find out
which care center is open on the weekendsbecause they are rotating.
So we always advise membersto call and schedule appointments.
You know, if they,
if they need to get in at that pointin time that they can do that.
And can they make appointmentjust a regular appointment.
(33:28):
They go online and make that appointmenta line.
Definitely.
So what we always recommendis that for that very first appointment,
the consultation appointment to go ahead
and make that call,once you're in the system,
then you can make all of your regularlyscheduled appointments on online.
So you go and you have that initial visitusually takes about 45 minutes
to an hour.Where they actually sit down right
(33:49):
and listen to what it's not 7.5minutes, right?
Okay.
It's a real opportunityto sit down and talk to the provider
and let them hearabout your health history and what you do.
Yeah.
And the Spira Care experience is a lotdifferent than a traditional, experience
or the PCP office.
They have consultative roomswith comfortable seating in there.
(34:09):
With a table.
You can you can talk eye to eyewith the provider that's there.
I mean, you're not doing this. Yeah.
The doctor's over here on the computerand you're here.
The doctor's over herefilling in the computer screen.
Oh, you're 7.5 minutes is up next, right?
Yeah, it's a little different.Most of the time.
You spend less than 7.5 minutessitting in the waiting room.
Yeah, I know.
(34:29):
You take it back.
So, the design,the features, the view, the experience is,
wonderfully different.
It is. Thank you for doing this today.Yeah.
We're going to get you back.
Okay. When the brand new groupplans are released.
So we can tell the audiencewhat's going on there. Yeah.
So if you're a broker, if you'rean individual, if you're an employer,
(34:52):
there are changes coming,and these folks can help you through that.
They've got a product that canfit your budget and fit your needs.
I don't care what it is.
And you marry this up with the Spira Caremodel and you've got a value proposition.
It's hard to beat if you want information,if you want help.
877-467-2145.
877-467-2145.
(35:14):
You know, I've been a, my wifeand I've been Blue Cross and Blue Shield
members for, I think, the last 35 years.
It's been a long time. Okay.
Local customer service.
They're good peopleand they do what they do really well.
So thanks againfor coming up here again today.
And now I leave you with this thoughtfrom Doctor Martin Luther King.
Americans must learn to live togetheras brothers and sisters,
(35:35):
or we will surely perish togetheras fools.
Truer words are never spoken.
Thank you for listening to America'sHealthcare Advocate
broadcasting here on the HIARadio Network.
Coast to coast across the USA.
And now America's Healthcare Advocate,Cary Hall.
Hello, America.
Welcome to America's Healthcare Advocate.
Show broadcasting coastto coast across USA.
Here on the HIA Radio Network, you canlearn more about us going to our website.
AmericasHealthcareAdvocate.com.
Also your favorite podcastplatform, SoundCloud, whatever it may be.
(00:22):
Spotify, Rumble, all of them.
We're on 16 of them and our YouTubechannel, America's Healthcare Advocate.
My producer today, Mr.
Dave Thiessen, behind the cameras,
doing what he always does,bringing all these shows together.
They go up on our podcast platformsand our YouTube platform.
And Garner Cowdrey,who is behind the microphones here
in our beautiful Cumulus Studios.
(00:44):
If you need help,if you are, chronologically challenged
or you are looking for individual ACA,the lovely Carolee
Steele at RPS Benefitsby Design, will be happy to help you.
You can reach her at 877-385-2224.
And if you're looking for employersponsored
health insurance,Maria Ahlers is also happy to help you.
They have access to all the great plansout there, including those brand new
(01:08):
Blue Cross and Blue Shieldplans are going to roll out this year.
And so in studio with me, Mr.
Barron Roberts from Blue Cross and BlueShield of Kansas City. Welcome.
Thanks, Cary.
I haven't done a show like this,I think in probably six years.
And now I'm going to tell you whyI just said that.
So here's what's going on in the ACA
marketplace that I warned youthis was going to happen some months ago.
(01:31):
This is this is what we're looking atwith carriers.
Celtic Insuranceincreased this year 24.4%,
Medica 29.2%.
UnitedHealth Insurance 10.7%.
You want to tell us what the Blue Cross
and Blue Shieldincrease is going to be this year? Yeah.
So in in Kansas we're looking at a -4.1%.
(01:52):
And in Missouri a negative six.
Did you hear what I just said.
I reversed that Cary.
That's all right. Yeah that's all right.
The point is they’reactually going to be a premium reduction.
Now the last time I did a radio broadcastwhere there was a decrease in premiums
was Ron Rowe, about eight years ago,if I remember correctly.
So it's been a while. All right.
(02:12):
And this is a great piece of newsfor everybody in the Kansas City metro.
So I'm going to repeat that.
So they're looking at Missouri at a -4.4%.
And in Kansas a -6.1%.
So there must have been a lot of workwent into this.
If you're bucking the whole marketplace,
okay, all the national carriers, etc.,
(02:35):
and you're coming in at numbersthat are good,
and then we're going to talk about
some of the specific plansyou're going to offer.
They're going to be very different.
But how did you guys get to this.
Yeah we put a lot of workdesigning these new plans.
We gathered member feedbackfrom across the community.
We gathered our broker partner feedback,
months and
months ago to put together plansthat would fit,
(02:57):
the members of our community.
You know, it,
when we talk about the independentBlue Cross plans, like Blue
Cross of Kansas, Blue Cross of Nebraska,Blue Cross of Kansas City.
You know, there's the taglinethat always comes to mind for me
when I look at that versusthe big carriers.
The big Aetna’s,the big UnitedHealthcare's.
(03:18):
the Cygnus, and that is we're Main Street,not Wall Street.
And you're right down here on Main Street.
You know, you serve this market.
You've been herefor how many years? Over 85 Years.
85 years in Kansas City.
And you're able to come to the peoplein this city and say,
we're going to cut premiums this yearby 4.4% Missouri and 6% in Kansas.
That's pretty significant. Absolutely.
(03:40):
There's a lot going on in the ACAthis year.
You know, there's enhanced subsidiesthat are going away or expected to go away
at the end of the year unless there'ssomething that changes about that.
You'll have a $5, additional premium
applied to your billif you don't go in and update your income.
It's a very active open enrollmentthis year.
And we would encourage everyoneto go out and review their details
(04:03):
within their marketplace accountto ensure that they are getting,
assessed the right premium for one,but also evaluate their options.
And as you mentioned,we're giving decreases this year.
We're going to be much more competitive.
Well, you’regoing to be much more competitive.
And there's a tsunami coming.
I've been telling people thisfor the last four months.
Okay. I've done multiple shows on this.
(04:24):
There's a tsunami coming that, no longerare you going to be able to self affirm.
You're actually going to have to,
you know, have documentationthat says you made ‘X’.
The automatically renewingsubsidies are going from 400%
of the poverty level back to 150 to 200,which is where they were
before we had the expansion in 2021.
Well, that's going away now.
(04:45):
So there's going to be massive marketdisruption in the marketplace.
Between 90 and 93% of Americans
today on the ACA,have the enhanced subsidies.
So 90 to 93% are going to be affectedby these changes.
That's huge.
All right.
And so what BlueCross has done isthey've stepped up to the plate
and said, we're going to buck the markettrend.
(05:08):
You guys are taking a risk here.
There's no guarantee.
You know this is going to work outfor you guys in a year from now.
You're not going to be going, oh, Lord,you know, but the fact that you're willing
to make that commitment to this communityafter 80 years of serving
this community says a lot about Blue Crossand Blue Shield of Kansas City.
You know, most certainly.
And we've done a lot of things toto get there.
(05:29):
What we're looking at different caremanagement programs.
In addition to that, we're rolling outa brand new network in 2026.
Will help us get to the pricing pointthat, members are looking for.
Yeah.
And that new network
you’re going to have,
we'll talk about that when we get intothe next segment of the show.
And then obviously, Spira Careand how that's going to fit into
(05:49):
the equation is really interestingbecause we're seeing a lot of initiatives
now for, primary care,direct primary care,
getting away from the hospital models,the other models,
which is kind of funny because how longSpira Care have been in existence.
Yeah, since 2018. Okay.
So I mean youthe compliment Danette Wilson.
Okay.
For having,
(06:09):
you know, the vision to say we'regoing to do something really different.
I remember when everybody was like,this is never going to work.
Well here we are in 2026.
And guess what.
Not only is it working, it's workingphenomenally well.
Yeah. Very well.
Our members are reporting,96% customer effort
(06:30):
score at Spira Care,which is a true testament
to the experiencethat they get there, the accessibility,
and and being able to get to a providerthat, keeps costs low.
Let's give folks the dates when they canwhen this is all going to start with OEPs.
For ACA, you'll have a shopping periodor shopping window towards the tail
end of October,so you can go out and see what
(06:52):
the different prices and plansthat are available.
And then open enrollment startsNovember 1st
up until December15th for a 1/1 effective date.
And then if you're enrollingfor a 2/1 effective date,
that enrollment can come in after December15th up to January 15th.
And that's it.
That's it.
Okay.
So here's my admonitionto all of you out there in the audience.
(07:15):
All you folks like to procrastinate.
This is one yearwhere you better not procrastinate.
Okay.
You know, I'mgoing to give you the phone number,
and I'm going to suggest youthat you probably you ought to start
making some calls and start talkingto people and get ahead of this thing.
So you can call the folks down at BlueCross.
They can they can chat with you.
They can set up a time to talk to youafter OEP, whatever you want to do.
(07:38):
But you need to get ahead of thisbecause once this tsunami hits,
you guys are going to get buried.
You're the only plan in townthat’s offering decrease,
you're going to get hammered.
We're going to get a lot of calls.For sure. Yes, you are.
And there's going to be a lotthat has to happen here.
So the phone number is 833-467-2145.
833-467-2145.
(08:00):
And the website is bluekc.com. Yes. Yep.
All right.
So if you want informationyou can go up to the website.
But I would strongly suggest
you start making arrangementsto have these conversations now.
So you're not caught at the last minute.
Because as I saidit's going to be a tsunami.
There are a lot of changes coming.
A lot of folks are going to be affectedby these changes.
We come back to the break.
(08:21):
We'll talk some more about thisand how and the new plans
and the new networkand all that they’re doing,
and then we'll switch gearswhen we get to the third segment,
and we'll start talking aboutwhat's going to happen
to the small employer,because small employers on ACA
type plans are also going to get hitwith very significant increases.
What is Blue Cross doing to address that,and how are they addressing that
(08:41):
so they can help the small employerin the marketplace?
Stay tuned.
We'll be right back after the break.
You're listening to America'sHealthcare Advocate
Broadcasting here on the HIARadio Network.
Coast to coast across USA. We've got more.
Stay right there.
That phone number once again.
833-467-2145.
Stay right there. We'll beright back after the break.
(09:12):
Welcome back.
You're listening to America's HealthcareAdvocate show, broadcasting coast
to coast across the USA here on the HIARadio Network.
Once again, you can find out
more about us by going to the websiteAmericasHealthcareAdvocate.com.
You have an email.You want to send me a note?
Please do so.
Go to the website. I'm happy to help you.Any way I can.
I want a shout out to WNRP, AM 1620
(09:35):
and FM 95.3 Pensacola, Florida.
Happy to have those folks on boardas part of America's Healthcare Advocate
family broadcasting down thereevery Saturday at 8:00 in the morning.
And we love Pensacola, Florida,by the way.
So, all right, let's switch gears now.
And we kind of gave peoplea little tease there.
This new plan, which I'm hearing a lot.
(09:57):
In fact, we just had the folks
from RPS Benefits by Design up here,and they were talking about it.
And you guys have had a big brokermeeting the other day,
and there's some pretty excited brokersout there to learn about this new plan
that's coming in play,and what a difference
it's going to make people.So let's talk about it. Yeah.
What's it going to be called. Yep.
It is going to be calledthe Simply Blue Plan.
Simply Blue. All right.
(10:19):
And we'll
actually have three onein each metallic category.
So gold, silver and bronze.
We're pretty excited about it.
At the
smaller rollouts that we've done so far,brokers are getting excited about it.
We had a group up here this morning.It's pretty excited about it.
Yeah.
So, the price point on that,that will be our lowest price plan
that we have available.
(10:40):
It'll be offered in the Johnson County,Wyandotte County and Jackson County
metro area. Okay.
And it'll be a partof what we call the Blue Metro Network.
Okay.
That'll consist of Saint Joseph,
Saint Mary's UniversityHealth and Providence.
And it also includes UniversityHealth Lakewood as well.
Lakewood and then downtown.
(11:02):
Yep. Okay.
Then ProvidenceHospital over in Kansas City, Kansas.
That was the other one.
Saint Mary's down south. In Blue Spring.
and Saint Joseph.
So it’s a narrow network.
But the price point is going to be.
Much better.
You know what people are goingto have to do is be willing
to accept a narrower networkin order to get that price point.
(11:24):
The good news is you're giving theman option.
Absolutely.
They're not going to seewith the other carriers so
you're addressing the issueby getting creative
and giving them an optionso that somebody,
you know, if they do lose their subsidyand they need coverage,
at least they can keepthey can still stay in Blue Cross. The.
(11:44):
Whole nine yards.
Okay.
Now is Spira Careaccessible on those plans.
So each one of those plans will haveaccess to all nine Spira Care centers.
That's huge. Yeah. All right.
So now you just took primarycare out of the equation
from the standpointdid they have to drive to a facility.
They've got one of the nineSpira Care centers.
So you're connecting the two now.
(12:05):
So all of their primary care,behavioral health,
all the other things that go withthat will be in Spira Care.
Yeah, they'll have access to that.
And, access to Spira Care is much fasterthan a traditional primary care.
23 days to a typical wait to get into see a primary care doctor.
Then you get 7.5 minutes.
(12:26):
That's the average timeyou get with your primary care.
Little different. In Spira Care.
Talk about. That. Yeah, yeah.So in Spira Care.
You can get inand get your original orientation
visit set up much earlierthan traditional PCP office visits.
And then on top of that for sick careor a little bit more urgent type care.
You can get in to see Spira
within a few days, if not the same day,depending on the circumstance.
(12:49):
To me, when you're balancingthat narrow network piece
for cost effectivenessand but you're not saying to them, well,
you're going to go find a new primary careprovider.
No, you can come to Spira Careand we'll take care of you here.
We've got nine clinicsaround the Kansas City metro,
so you're giving them an option wherethey've got primary care, taken care of.
(13:11):
Whatever they need is right there.
If they need major medical,they can go to one of the hospitals
and get major medical.
Absolutely.
And hit on one more thing there Cary.
Care at SpiraCare is at no cost to members.
So they've got easy access,affordable access.
They'll have a great experiencethere and care is at no cost for Spira
Care members. Yeah.
So there's yourthere's your key takeaways right there.
(13:32):
And you heard him say in the last segment,96% of the people coming away
from Spira Care are telling themthey're doing a good job.
All right. So if you're not going to
make co-pays.
You're not going to have to payout-of-pocket costs for this.
When you think about marryingthat up with the plan, it's
going to save youa significant amount of money.
That sounds like a pretty winwin deal to me.
(13:54):
Yeah, absolutely.
That is, taking total cost of care downfor members and families for sure.
So rolls out. Win.
This will roll out,January 1st is a new product.
Open enrollment starts 11/1.
Great. Startlooking for that plan starting 11/1.
And if they want to call
and just have a consultation with somebodyand talk about that plan,
they don't have to wait to open enrollmentto make a phone call to say
(14:16):
this isn't Medicare. Right? Okay. Right.
Yeah.
Where we got the thought police out theregoing, you can't call it.
You can't talk to anybody. Yep. They can.So this is a different deal.
This is ACA.So they can call anytime they want.
If they've heard about this planit's called Simply Blue.
That's pretty easy right. Simply Blue.
And there are three plans.
There's there's the there's the gold.
(14:38):
There's the silver and there's the bronze.
So you've got three separate plansto offer.
I assume there's going to have differentdeductibles. Correct.
2000, 4000 and 6000.
And the premiumsall vary depending on the plan. Okay.
So if you know, if you'reif you're one of those folks
that's chronologically challenged,you're in your 50s,
you probably don't need a $2,000deductible
(14:59):
because you’re not running to the E.R.,the urgent care and all the other things
you're going to have to dowith the household children.
So you could go to a $5,000 deductible.
Can that be tied to an HSA?
So actually new for 2026,
bronze and catastrophic planswill be eligible for HSA, compatibility.
Okay. So that's huge. Yeah.
(15:20):
And the thing about the HSAis that I always try to get people's
headsis it money going in is tax deductible.
So you made 100 grand.You're going to pay taxes on 100 grand.
No you're not.
You're going to take 6300 off that.
It’s your moneyyou're putting into your account.
Oh and by the way, when you take it outit's tax free.
So if you went to the higherdeductible plan
and you had to gohave a surgical procedure,
(15:42):
you've already got your deductible thereto pay to get it done.
Correct.
And if you don't use it,you don't lose it.
Unlike,Like an HRA or something like that.
All right.
This plan is not a flex. It's not an HRA.
This money rolls over every year.
So you can continue to add to itSo if you put all those pieces together
you got some answers here. Absolutely.
(16:03):
And that's that's really kind ofwhat BlueCross
Kansas City has always been known for
is that you have the answersand you're serving this community.
And this is a great opportunity.
You know, once again,they're called Simply Blue.
I strongly suggestthat you are the up on the website, yet.
No. They won't be up on the websiteuntil late October.
Okay, so. During the shopping seasonin. October, you can go up there.
(16:24):
They'll be up thereif you just want to call
and have a conversation with himabout this, you can do that.
833-467-2145.
833-467-2145.
By the way, there are 1 millionpeople out there across the country
that are losing their coveragebecause Aetna’s pulling out of the market.
You folks probablyought to be the ones on the phones first.
(16:45):
Okay.
And looking for these plansand to see what they can do because,
come January 1st, all the Aetna plansare pulling the pin on ACA.
They're going to be gone.
And I and I read to you earlier what'sgoing to happen with the other plans.
They're going to be significant increasesacross the board.
BlueKC continues to lead the wayas the local hometown carrier.
We'll be right back after the break.
(17:05):
You're listening to America'sHealthcare Advocate broadcasting
here on the HIARadio Network coast to coast across USA.
Stay rightthere. We've got more in the next segment.
(17:25):
Welcome back.
You're listening to America'sHealthcare Advocate show broadcasting
coast to coast across USA here on the HIARadio Network.
My producer behind the microphones, Mr.
Garner Cowdery behind the cameras,
putting all these shows togetheras he does every week.
Dave Thiessen
in studio with me, Barron Roberts, BlueKCwe're talking about the coming tsunami
That's what's going to happen,both on the individual side
(17:48):
and on the group sidewith anything associated with ACA.
And how is that going to play outfor all of you out there in the audience?
So we've talked about
on the individual side and what Blue Crossis doing to lead the way.
They're actually going to havepremium reductions on the individual side.
Right now we're going to switch gearshere, and talk about
what are the answers to the employersout there, the small group
(18:09):
employer,the employer under the 100 lives.
What are the answers to them?
What is Blue Crossdoing to address the issues
that they're going to deal with?
Because that's going to happen.
All right.
And if you're you know,you need to talk to your broker.
If you don't talk to your broker, callthe folks at Blue Cross and Blue Shield
at 833-467-2145.
(18:30):
If you want to have a conversation beforeyou get to the point where you've got
the renewal, now you're looking at a 20%increase that came from another carrier.
you might want to give them a calland have a chat.
All right. Let's talkabout what you're going to do.
Alright,
how are you addressing this marketand what are you doing to help employers
deal with these issuesand the brokers out there that are
(18:51):
the ones representing your products?
Yeah, absolutely. Gary.
So we put a lot of work into the 2026plan designs for small group.
Number one.
We went out and surveyed
our broker community and asked them,what are employers asking for?
We took those notes.
We took, feedback from our team,and we developed new plan designs
for 2026, to help reduce the overall,
(19:15):
premiums on the baseline for employers.
And you're confidentthis year's new rollouts,
what are they going to look like?
You know, we've already had a coupleof smaller rollouts, our broker community
and our brokers that we've presented
in front of our pretty excitedabout these changes.
We've got updates to Blue SelectPlus eligibility, more members,
(19:35):
will become eligible
to enroll in Blue Select Plus, Blue SelectPlus has Spira Care.
We have brand new plan options.
Some of them have higherdeductibles, new plan designs.
Some of them have no deductibleon medical, whatsoever with fixed co-pays.
So that's going to open upa lot of opportunity there.
Run that by me one more time.
No deductible on medical.
(19:56):
And so we’ll have just co-pays on primarycare office visits, specialist visits.
And some of those planshave just co-pays on inpatient as well.
That's going to be remarkable.
Yeah.
That's going to be that goingto be a game changer for people.
Let's go back to Blue SelectPlus you talked about some things.
So what are some of the thingsgoing to happen there. Yeah.
So for Blue Select Plus, for many yearsnow we've been getting questions
(20:18):
and really requests to expandour Blue Select Plus eligibility.
Right.
So you know members that live in MiamiCounty or right outside Johnson County,
right outside Wyandotte County,
we have employer groupsthat are within those counties
today that have membersthat live just across the county.
Line, right.
(20:39):
That have not previously been eligiblefor Blue Select Plus or Blue Select
Plus with Spira Care. Right.
And so starting in 2026,we're actually opening up some eligibility
there and allowing those membersto enroll in Blue Select Plus and Spira.
Wow. Yeah.
So I think they're going to be excited.
Those members that live in those countieswill have, new plan options.
(21:00):
The Spira Care experienceif they enroll in the Spira Care plan.
And those employers may be a little bitmore open to offering,
that plan option as well.
Yeah.
And the beauty of that is we talked aboutSpira Care in the last segment.
We’ll touch on it againa little bit because the beauty of that
is that the employer can say herewe're going to go to a higher deductible,
but all of your primary care,behavioral health, X-rays,
(21:24):
labs, all that is going to be handledby Spira Care.
All right.
And if you need to be referred out,they'll take care of doing that.
So you're taking away the biggest obstacleto care that people have.
That is I can't afford a $50 copay, okay.
Or a $75 copay to go to a specialist.
Okay.
But I can go to Spira Careand I don't have to pay anything.
(21:45):
So now you're marrying that to this plan,which keeps affordability in line
and also says to the employee,my employer really does care
because they put this plan in placeso that I can go to Spira Care,
not just the employee,but the employees family as well
up there on the plan, right? Right.
and when you think about total cost ofcare savings, if you got a family of four
(22:06):
of going to the providerevery year on top of reduced
premium, you're going to savea significant amount of money.
Yeah.And you know, I've got six grandchildren.
And I can assure you that my two daughterswith those six children,
there is not a week goes by that there isnot a visit at the urgent care, the E.R.
or some specialist doctorthat they've got to go to
(22:28):
because there's a new issuewe've got to deal with.
Okay.
So for families, to me, this just seemsto make an awful lot of sense.
Yep. And those care centers also offer,
servicesthat support pediatric care as well.
So if there's younger children there,they can help them as well.
Yeah. So we've got nine locationsaround the metro.
(22:49):
Where are. They?
Yeah, absolutely. Cary.
So, Tiffany, Liberty,Legends, Shawnee, Olathe,
Overland Park,Independence, Lee's Summit and Crossroads.
Well, you've got onealmost everywhere in the city.
All over the city.Nine locations for Spira Care.
Anywhere in the cityyou have access to Spira Care.
So in other words,there's some places close to you.
(23:10):
Yeah. Okay.
You're not going to have to drive 45minutes to an hour to get to a facility.
Right.
And the whole the whole conceptof putting the Spira Care’s
all around the Kansas City community,if you look there, really circled
all within the 435 interstate.
So any member within the Kansas Citycommunity
should be able to get to a Spira Carewithin 10 to 15 minutes.
(23:30):
And this is the solution.
That as an employer,you really need to take a look at.
If you want to keep your employees happy,give them a benefit that’s going to mean
something to them and, give them accessto the kind of care they need.
This is an opportunity to do that.
Talk a little bit
before we go to break about levelfunded, fully insured in the ACA.
(23:51):
Our Level Funded, option for 5 to 99
size employers, 5 to 9 enrolled employees.
That optionis available for the small groups.
A lot of groups are finding those optionsto be
you know, a great product,an affordable product.
It is a very attractiveand growing market in that space.
(24:14):
For ACA, that's 2 to 50.
2 to 50 enrolled employees.
And then for fully insured, underwritten,it's 51 to 99 enrolled employees.
So explain that because that that.
I'm an employer now I've got 75 employees.
So if I want to move to it and I andmy workforce is trending below 45.
(24:35):
So now I know that you know thatif they're trending
below 45, they're going to be a healthierbunch, right?
They ought to be.
We'll make an assumptionthat they're reasonably healthy.
Okay.
So having said that,when they go to that model,
they're going to be judged on that groupas a group, not being judged
(24:55):
on this giant pool of people over here
with ACA, a lot of sick peopleand other people on it.
It gives them an opportunity
if they've got a pretty healthy group or
groupthat doesn't have a lot of major issues
where they can actually puta program together,
that really is kind of tailoredto what they need, correct? Yep.
And in addition to all the plannedchanges, the new plans we have coming out,
we've also opened upour underwriting guidelines Cary.
(25:18):
Oh really? In addition to. That.
Well, that's a big deal.It is a huge deal.
Yeah okay.
So explain what that meansbecause I'm sure the audience out there
what does that mean.They opened up their underwriting.
Yeah.
So, we're making it easierfor employer groups to apply for coverage.
Those that have at least tenor more enrolled employees on the plan.
And so what I mean by that is we need a
(25:40):
we need a group census with at least tenor more enrolled on the plan.
We need that group app.
And we need a couple of other piecesof information and we can turn around
and quote that group on, level fundedor fully insured?
51 and 99.You know, that's pretty amazing.
You've got a suite of products here.
Yeah. I'm kind of talking to the brokeraudience now a little bit.
(26:02):
You've got a suite of products herethat are addressing
concerns in the marketplace,and I'm not seeing this anywhere else.
I'm not seeing it from the other carriersout there.
I'm seeing carrierspull out of the marketplace,
and I'm seeing articles in the Wall StreetJournal, other places talking about
how difficult it's going to be for themto continue this year.
But you're seeing something completelydifferent here by the hometown carrier.
(26:24):
And if you're the broker out there,you really need to engage in this.
If you haven't gottento one of their seminars, the webinars
to learn about these products, you need tobecause you're going to be getting calls
from your clients,who are going to hear this show
and the commercials run during the weekwhere we talk about these kind of things.
They're going to ask you,
why haven’t you been telling me about thatnew Blue Cross plan?
(26:46):
Okay.
Because they're going to be a host of newBlue Cross plans.
They're going to address,
what'sgoing to happen in this marketplace.
And I'll repeat what I said earlier.
We're going to see a tsunami in changesthis year on the ACA.
Small group side across the board.
Impactedby all the changes that are happening.
And it's importantfor you to get ahead of that.
833-467-2145 if you're an employer, okay?
(27:10):
And you just want to have a conversation,they're happy to do it.
833-467-2145
or the website bluekc.com, bluekc.com.
We'll be right backafter the break to wrap it up, stay tuned.
You're listening to America'sHealthcare Advocate
broadcasting here on the HIARadio Network.
Coast to coast across the USA.
Don't go anywhere.
(27:37):
Welcome back.
You're listening to America's HealthcareAdvocate show, broadcasting coast to coast
across the USA here on the HIARadio Network.
You know,
I do these shows to get informationout to all of you
aboutwhat's going to happen in the marketplace.
I got I have BlueKC up here todayto tell us what they're doing
to address the concerns that people aregoing to have as we get closer to renewal
(27:59):
on the individual side and on the employersponsored health care side.
They've got answers.
They've been here for 83 years, okay?
They've got answers.They're the hometown carrier.
They're the only carrier in this marketthat's actually reducing premiums
on the individual side.
So again, if you're a brokeror if you're an employer or an individual
and you want information833-467-2145 is the phone number.
(28:24):
They're happy to talk to youand get you set up for
what's going to come down the pikethis year 833-467-2145.
And the website bluekc.com.
All right, let's go back to SpiraCare a little bit
because this is such a unique valueproposition.
Now, and, you know, it's funny,you don't have to wait
23 days to get in to see a doctor. Yeah.
(28:45):
And the visit is probably goingto last longer than 7.5 minutes.
Right.
I know the average visit with SpiraCare is about 30 minutes.
Okay.But it's it's a very different care model.
So talk a little bit about that
and why that is really something bothemployers individuals should consider. So
you know starting off with just the SpiraCare story, we rolled it out in 2018.
Over time, we've added more care centersacross the Kansas City community.
(29:09):
We're up to nine so far.
With that,
the idea was to ensure that every memberwithin Kansas City
could have access to Spira Care easilyand relatively close.
So each membercan get to a Spira Care center
within 10 to 15 minutes at least,that was the design that we had in mind.
And it worked.
Yeah, yeah.
(29:29):
Members are you know, reportinga great experience there.
We grade ourselves on the customer effortscore of our members
not only the Blue Cross members,but also our Spira Care members.
And for the those Spira Care members,
the customer effort score is 96%.
And just to put it in perspective,
you know, gold plans,
(29:50):
industry best is right around 72%.
So holy cow.
Are you serious? We're getting great.
Great feedback from members on theexperience that they have at Spira Care.
And have you got the capacity to handlewhat's going to be coming down the pike?
Because I got a funny feeling, pal.
Your phones are going to be ringing.Yeah, yeah.
We do.
Each of our care centers have capacityto continue to grow and grow membership.
(30:14):
Some of the newer oneshave even additional capacity
to have additional rooms in therethat they can add on.
So, we're pretty confident our, the growthopportunities we have ahead for 2026.
So there is one component about Spira Carethat I always thought was unique
because nobody else does this.
I mean, there are there are other modelsout there for direct primary care.
But your behavioral health, I mean,this is a big deal to Erin it's a big deal
(30:37):
to Jenny, you know, Christina Lively,all the C-suite people at Blue Cross.
Talk a little bit about thatand the fact that,
you know, it's right there in the center.
You don't get referred outto go see somebody outside.
You can start right therein behavioral health.
And to me, this is important,especially for people with kids these days
(30:57):
that are dealing with issues,whether it's, you know, cyber bullying
or what's going on at schoolor just some of the talk a little bit
about that whole behavioral health pieceand how that fits.
Because I think that separatesSpira Care from everything else out there.
Yeah, yeah.
So, as you mentioned,it's very important at BlueKC
you know, our leadership team,all of our all of our team members,
(31:18):
to provide accessto behavioral health services,
not only at Spira Care,but also through all of our apps
and all of our resources and mindful,we've got a ton of resources available.
But at Spira Care,we did integrate behavioral health care,
to ensurethat members had access to that service.
And there is screenings that occur withinthe Spira Care centers to help understand
(31:40):
if members need that type of careand we help get them there.
Yeah.
And, you know, for the mother,you know, that’s
got 2 or 3 children and she's got onethat's having a problem.
She doesn't have to worry about goingsomeplace else.
She can go to Spira Care
and that child can be privately counseled,whatever they need to do.
And the whole thing workslike it's supposed to.
(32:01):
Yeah.
So, in addition to that,there's no cost at Spira Care.
Well, that's that's a big piece, right?
Yeah, yeah, it's the,you know, all the co-pays are gone.
So, you know, that's criticalto talk about some of the other services
that Spira Care offers.
You I know labs and X-rays are availablein certain facilities.
How are you handling prescription drugs.
The rest of it.
Yeah.
So, each of our Spira Care planshave, prescription drug,
(32:25):
model plansthat enable, low cost for prescriptions.
So tier one and tier two are co-pays,and then tier three,
typically havea level of coinsurance. But,
the Spira Care centers will refer out
those prescription drug needs to,local pharmacies that are in network
so members can get accessto those prescriptions.
(32:46):
So that's all part of the plan.
They don't have to go dealwith another plan or some other issue.
That's all going to be handledthrough the Spira Care facility.
It's all built in.
Okay.
That that that's pretty significantin terms of how that works.
Are you doing anything with urgent careafter hours visits?
Yeah.
So some of the care centers
have not only they have after hoursvisits,
but some of them are openon the weekends as well in case.
(33:07):
That's new because that. Yeah.
Okay. That's that's.
Yeah.
So it's, you know, you have to calland make sure, you find out
which care center is open on the weekendsbecause they are rotating.
So we always advise membersto call and schedule appointments.
You know, if they,
if they need to get in at that pointin time that they can do that.
And can they make appointmentjust a regular appointment.
(33:28):
They go online and make that appointmenta line.
Definitely.
So what we always recommendis that for that very first appointment,
the consultation appointment to go ahead
and make that call,once you're in the system,
then you can make all of your regularlyscheduled appointments on online.
So you go and you have that initial visitusually takes about 45 minutes
to an hour.Where they actually sit down right
(33:49):
and listen to what it's not 7.5minutes, right?
Okay.
It's a real opportunityto sit down and talk to the provider
and let them hearabout your health history and what you do.
Yeah.
And the Spira Care experience is a lotdifferent than a traditional, experience
or the PCP office.
They have consultative roomswith comfortable seating in there.
(34:09):
With a table.
You can you can talk eye to eyewith the provider that's there.
I mean, you're not doing this. Yeah.
The doctor's over here on the computerand you're here.
The doctor's over herefilling in the computer screen.
Oh, you're 7.5 minutes is up next, right?
Yeah, it's a little different.Most of the time.
You spend less than 7.5 minutessitting in the waiting room.
Yeah, I know.
(34:29):
You take it back.
So, the design,the features, the view, the experience is,
wonderfully different.
It is. Thank you for doing this today.Yeah.
We're going to get you back.
Okay. When the brand new groupplans are released.
So we can tell the audiencewhat's going on there. Yeah.
So if you're a broker, if you'rean individual, if you're an employer,
(34:52):
there are changes coming,and these folks can help you through that.
They've got a product that canfit your budget and fit your needs.
I don't care what it is.
And you marry this up with the Spira Caremodel and you've got a value proposition.
It's hard to beat if you want information,if you want help.
877-467-2145.
877-467-2145.
(35:14):
You know, I've been a, my wifeand I've been Blue Cross and Blue Shield
members for, I think, the last 35 years.
It's been a long time. Okay.
Local customer service.
They're good peopleand they do what they do really well.
So thanks againfor coming up here again today.
And now I leave you with this thoughtfrom Doctor Martin Luther King.
Americans must learn to live togetheras brothers and sisters,
(35:35):
or we will surely perish togetheras fools.
Truer words are never spoken.
Thank you for listening to America'sHealthcare Advocate
broadcasting here on the HIARadio Network.
Coast to coast across the USA.
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