Blue Cross Blue Shield of Massachusetts will discontinue all PPO and EPO plans in the merged market (the combined individual and small group markets in Massachusetts) after 2026, the company confirmed to Becker’s.
The insurer said it will automatically map all merged market PPO and EPO groups to the closest corresponding HMO Blue New England plan to avoid a coverage gap, and that the majority of affected members should see no major difference in network access.
The company attributed the shift to higher overall healthcare utilization and severity in the merged market, along with state data showing a decline in small group participation as employers and individuals struggle to afford coverage.
BCBSMA said the change will have the greatest impact on the approximately 13,000 PPO members who live outside New England, saying it is working to help them find alternative coverage.
For employer groups that still want PPO access, BCBSMA is recommending two alternatives. Qualified groups of 10 to 50 employees can use Blue Funding Solutions, a level-funded option the insurer said allows employers to maintain PPO access while gaining more financial control. Groups with at least 10 employees on payroll and seven enrolled can also work with BCBSMA’s professional employer organization partner, GenesisHR Solutions, which bundles health plans with HR, payroll and compliance services.
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