Texans who want to buy health insurance plans on the individual marketplace created by the Affordable Care Act, also known as Obamacare, can start enrolling today through Dec. 15 on healthcare.gov.
Like last year, the enrollment period is shorter than it was during the Obama administration – just six weeks – and the Trump administration has also cut funding for outreach and navigator programs, which help people sign up for plans.
In Central Texas, though, local groups that receive funding outside of federal grants are available to help. Those groups include Foundation Communities and Enroll ATX.
Here’s a breakdown of some things you should know about open enrollment in Central Texas this year:
1.) The market hasn't changed much.
Like last year, there are still (the same) four insurance providers in the marketplace: Ambetter, Sendero, Oscar and Blue Cross Blue Shield. Those four providers are offering a total of 33 different plans this year.
"The plans and coverage are really comparable to last year," says Kori Hattemer, the director of financial programs at Foundation Communities.
She says there are several low-cost plans – and even plans with no premiums at all – that will give you a discount based on income. This year, some are more expensive, but some are cheaper. Overall, the marketplace prices are pretty stable compared to last year.
2.) Shop around - even if you had a plan you liked last year.
Despite the marketplace's stability, Hattemer says, individual plans may have changed in price.
“We recommend that everyone shop around,” she says. “The plan you have might cost more or less this year.”
3.) You've still got options for financial assistance.
Some of the basic structures of Obamacare are still in place. That includes financial assistance for people who qualify for things like Advance Premium Tax Credits (APTCs), which lower the cost of premiums.
Last year, 90 percent of Texans buying insurance on the Obamacare marketplace received APTCs, according to the Kaiser Family Foundation.
Hattemer says it’s important to look at what your insurance will cost you with those tax credits included – because it could allow you to get a better plan than you think you can afford.
"It might seem like a plan is cheaper," Hattemer says, "but when you actually look at your income information and your situation there’s a plan that actually gets you a lot more coverage for a lower price or similar price."
4.) Obamacare plans will likely have more comprehensive benefits.
If you buy insurance on the individual market – either because you don’t get insurance from your employer or you work for yourself – your best coverage options are likely still in the Obamacare market.
The Trump administration has opened the market to less regulated health care plans in its effort to weaken the Affordable Care Act. Health care experts say there are more short-term plans, limited plans and high-deductible plans available, but those plans have some serious drawbacks. For example, advocates have been warning that many of these plans won't cover emergency room care.
"A lot of the short-term plans exclude emergency services, most of them exclude maternity care, some exclude hospitalization," Hattemer warns.
Every plan on the Obamacare, or ACA, marketplace must include these essential health benefits:
- Ambulatory patient services (outpatient services)
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services (those that help patients acquire, maintain or improve skills necessary for daily functioning) and devices
"Plans outside of the healthcare.gov marketplace ... might not include those and often times do exclude some of the things that people have come to expect their health insurance to include,” Hattemer says.
Also, there’s also no financial help for those plans that are outside of the Obamacare marketplace.
5.) Obamacare plans cover pre-existing conditions.
Folks with pre-existing conditions can still buy a plan through Obamacare, though there is a lawsuit that could dismantle the provision. Many short-term or limited plans often don’t cover people with pre-existing conditions.
"Anyone with pre-existing conditions should really shop on the healthcare.gov marketplace," Hattemer says.
