Do you need health insurance? What to know about shopping for Obamacare

Texas continues to lead the nation in the number of residents without health insurance.

Among Texas adults under 65, 29% didn’t have health insurance last year, according to a new analysis from the National Center for Health Statistics. Texas had the highest share of uninsured residents last year, and was well above the national uninsured rate of 12.6%.

But many of those Texans without health insurance have the opportunity to purchase a health insurance plan until Jan. 15, through the Affordable Care Act, also known as Obamacare. And for some of those Texans, the plans will come with subsidies to help cover the cost of monthly payments.

Here’s what you need to know.

What is Open Enrollment?

Open Enrollment is the time frame during which Americans can pick a health insurance plan through healthcare.gov, the federal government’s insurance marketplace.

About 46% of Texans get health insurance through their jobs, according to census data. Other Texans, like those 65 and older, children, and people with disabilities, can qualify for public health insurance programs, like Medicare or Medicaid.

For people who don’t get health care through their jobs, or who don’t qualify for a public program, there’s another option. During Open Enrollment, which started Nov. 1 and runs through Jan. 15, Texans can look at the plans available and purchase one so they have health insurance coverage for 2023.

How should I pick a plan?

There are hundreds of different plans available on healthcare.gov.

If you’re unfamiliar with health insurance, or if terms like “monthly premium” and “deductible” are confusing, you should probably seek help from an “assister.” Assisters provide free help to people selecting health insurance through the marketplace, and do not work for or receive incentives from health insurance companies (which is often the case among specific health care agents or brokers). In Tarrant County, assisters are available at JPS Health Network and the North Texas Area Community Health Centers.

The types of plans available to you will vary based on where you live, your income, and whether you smoke.

Tamika Chambers, a financial advocate with the nonprofit Cancer Care Services, said you should consider not just the monthly cost you pay for the plan (known as a premium), but how much you would have to pay out-of-pocket for certain types of care, like emergencies, and whether you have to meet a deductible. If you have specific doctors, hospitals, or clinics that you already go to, you should call them and make sure they accept your insurance before picking the plan, she said.

Who can buy a plan on Marketplace?

U.S. residents who are citizens or lawfully present can purchase a health insurance plan on the marketplace.

But not everyone is eligible for financial help if they want a Marketplace plan. Most people who are offered health insurance through work are not eligible for financial assistance.

People who don’t have health insurance and who make less than 100% of the poverty level, or less than $27,750 for a family of four, also are not eligible for help.

Do I need health insurance?

Americans are no longer required to enroll in a health insurance plan.

But for almost anyone who needs medical care, it will be cheaper to get care if you have health insurance to help you pay.

“You never know what can happen in your life,” Chambers said. “You can save thousands of dollars if you have health insurance.”

What to avoid

Chambers said anyone looking for a health insurance plan on the marketplace should only browse plans on healthcare.gov. Other websites with similar names or designs often sell health insurance plans that are not compliant with the Affordable Care Act, and so might not include all of the benefits and coverage that most people need.

Where to get help picking health insurance

Both the North Texas Area Community Health Centers and JPS Health Network can assist you with enrolling in a marketplace insurance plan.

North Texas Area Community Health Centers: Call 817-625-4254 and say you need help applying for marketplace insurance, or make appointment at ntachc.org.

JPS Health Network: Call JPS Enrollment and Eligibility at 817-702-1001, or visit jpshealthnet.org/financial-resources/jps-connection.

Outside of Tarrant County, you can find health insurance agents or brokers by visiting healthcare.gov and clicking on “find local help.”

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