Open enrollment has started for the third year of the health insurance marketplace in Texas and several changes are in store that could affect your pocketbook.
First, Texas has fared better than most of the 37 states in the federal marketplace in terms of premium increases, according to the Centers for Medicare and Medicaid Services.
Comparing the second-lowest-cost silver plan as a benchmark, Texas saw only a 5.1 percent increase in premiums this year over last, CMS said. Dallas-Fort Worth fared even better with just a 3.9 percent increase.
Other states did not do as well. Seventeen states saw premium increases in the double digits, with Oklahoma showing the biggest jump of 35.7 percent.
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Across all markets, the benchmark plan saw a 7.6 percent increase. Federal data show that in 2016 nearly 8 in 10 returning marketplace consumers can buy a plan with premiums of less than $100 a month after tax credits.
The smaller local rate increases are likely due to strong competition. This year, those shopping for individual insurance in Tarrant County can choose from six insurers offering 63 plans, four more than last year.
And while Assurant Health has pulled out of the individual market in Texas and the rest of the country, New York-based start-up Oscar has entered the state in DFW and San Antonio, offering 11 plans in Tarrant County.
Oscar is designed to be consumer-friendly, offering healthcare services to its customers in addition to simplified coverage, according to Mario Schlosser, the insurer’s chief executive officer. In addition to an easy sign-up process at www.HiOscar.com, Oscar offers several free services like an annual physical, a 24/7 physician hotline to doctors who can prescribe medications and a wristband fitness tracker that policyholders can use to earn gift cards.
“We want to simplify the healthcare system and help navigate and guide you through the system,” said Schlosser. “We get rid of co-pays and co-insurance and show you only out-of-pocket costs. We offer an easy mobile app where you call us and we find your provider and book your appointments.”
Oscar has signed on the Baylor and Tenet healthcare systems for their local network, Schlosser said, offering around 2,000 doctors in DFW.
Schlosser sees a ready market in the state, with some 4.4 million still uninsured.
“There are still people who are not sure they need insurance in the state,” he said. “We want to do our part to get that number cut down.”
Blue Cross Blue Shield of Texas, the dominant player in the state’s marketplace with 570,000 of the 1.2 million enrollees last year, plans to continue its outreach with 60 educational events in DFW during open enrollment to capture more of the uninsured. In addition, its mobile assistance center will be traveling around the area; it’s scheduled to be at the CVS pharmacy on Boat Club Road in Fort Worth this weekend.
“The last few years have not been as seamless as they could have been in the marketplace,” said Dan McCoy, chief medical officer at BCBS of Texas. “This year we expect it to be smoother.”
Having health insurance in 2016 will be even more important at tax time. The penalty for not having insurance will more than double to $695 per adult and $347.50 per child, or 2.5 percent of income, whichever is greater. That could easily cost a family thousands of dollars.
Many still don’t think they can afford insurance, despite the Supreme Court earlier this year upholding federal subsidies in the state to help offset the cost, said Stacey Pogue, senior policy analyst for the Center for Public Policy Priorities in Austin.
“Polling shows that of the remaining uninsured, 73 percent think it’s important to have health insurance, but 60 percent didn’t know there were subsidies to help pay for it and 50 percent had not looked at the marketplace,” she said. “There is still an assumption that coverage is out of reach for them.”
But that may not be the case. A study by the Health and Human Services Department found that the average net premium for people receiving tax credits in Texas last year was just $72 a month, a 76 percent reduction from the $305-a-month average retail price. Around 84 percent of those who signed up for healthcare in the marketplace last year in Texas received tax credits to help pay for it, Pogue said.
Another study released in October by the Kaiser Family Foundation found that of the remaining 4.4 million uninsured in Texas, 35 percent are eligible for the either Medicaid or the marketplace subsidies.
So check out the marketplace — especially if you’re uninsured.
Teresa McUsic’s column appears Saturdays. TMcUsic@SavvyConsumer.net
Navigators. Community Council of Greater Dallas offers free appointments with navigators to walk through the sign-up process. To set up an appointment in Tarrant County, call 469-740-6071. For more navigator locations, go to www.GetCoveredAmerica.org.
Hotline. The federal toll-free call center is 800-318-2596 to sign up for a health plan by phone.
Online. The federal government has an online website to shop and purchase health insurance at www.healthcare.gov or for Spanish speakers, www.cuidadodesalud.gov.
Agents. Insurance agents can sign people up over the phone or at a home visit. For a directory of local agents, go to the Texas Association of Health Underwriter’s website at www.tahu.org.