As Texas consumers prepare for the fourth open enrollment to sign-up for or renew health insurance coverage under the federal Affordable Care Act, they face rising costs but could also receive more financial assistance.
Beginning Nov. 1, Texas residents can go to Healthcare.gov, the federal health exchange website, to sign up for health plans available in their area. But the sign-up period comes after several health insurers – including Aetna, UnitedHealthcare, Scott and White, and insurance start-up Oscar – have called it quits on the federal website. Texas consumers’ monthly health insurance bills could rise an average 25%, according to a federal Department of Health and Human Services report.
While Texas state leaders and legislators have relished not promoting anything related to President Barack Obama’s 2010 health law, 1.3 million residents signed up for coverage in 2016. The federal law requires everyone to have health insurance whether through the federal or state health exchange websites or through an employer, with some people qualifying for tax credits to help cover the cost. Those who forgo insurance face tax penalties in the spring.
Jamie Dudensing, CEO for the Texas Association of Health Plans, said the reason “health insurance premiums are expensive is because health care is expensive.” She said medical care from, drug prices to freestanding emergency rooms, is becoming more costly and consumers are feeling the brunt. Insurance companies have built pricing tools to help people understand what they are paying for.
Among Texas insurance policyholders, 74% could buy a plan for $75 or less per month after receiving a subsidy, while 80% could buy a plan for $100 or less after receiving financial help from the government, according to the HHS report.
“We are concerned about prices, but we’re not panicked about what’s happening because health insurance is available and it’s good coverage,” Dudensing said.
For insurers, a big concern is how people hop on and off plans throughout the year. Dudensing said uninsured people will sometimes become sick, get health insurance and cancel once they feel better. She said those tactics “completely negate” the point of health insurance and can affect prices.
But news reports over rising premiums and health insurance companies opting out of offering coverage in certain areas “shakes people out of complacency” to get more information, says Mimi Garcia, Texas director for Enroll America, a national organization that helps with sign-up efforts. She said some Texas navigators – trained people who help answer insurance application questions – have been receiving calls since September about the upcoming open enrollment, a sign that consumers are “actively engaged in their health coverage.”
Garcia also pointed out that while premiums are going up, consumers can expect more subsidies to help offset the cost. Eighty-four percent of Texans who bought a health insurance plan in 2016 received tax credits, with the average amount being $257 per month. Texans paid an average of $87 per month after subsidies. But some residents make too much money to qualify for subsidy help, a key point from Republican lawmakers that has troubled the Obama administration.
“The important thing is subsidies are going up as well so we’re really encouraging everybody to talk with an in-person assister to find out what plans there are,” Garcia said. “It’s about their own personal situation, and the vast majority of people in the marketplace, particularly those in Texas, are getting help.”
Read related Tribune coverage:
- The roughly 1.3 million Texans who bought health insurance under the Affordable Care Act will likely have fewer, more expensive coverage options in 2017, as health plans continue to announce they will no longer sell their products in Texas.
- UnitedHealthcare, a major health insurer, will no longer sell insurance on the Affordable Care Act marketplace in Texas next year, according to a letter filed with state regulators.
- Nonprofit workers in the Rio Grande Valley say they’ve seen an increase this year in the number of rip-off artists charging Texans for help signing up for health insurance – a service they are eligible to get for free.
Disclosure: The Texas Association of Health Plans has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.