Need health insurance? Here's what to know about shopping for a plan on HealthCare.gov [Fort Worth Star-Telegram]

Nov. 22—Almost one in every four non-elderly Tarrant County adults did not have health insurance in 2018, according to the county health department's estimates.

Although many Texans get health insurance through their jobs, some employers don't offer an employer-sponsored plan. And in Texas, only a relatively small number of adults qualify for the public insurance program Medicaid.

But for the next two months, Americans have another option to get health coverage. Americans can shop for insurance through Jan. 15 on healthcare.gov. And this year, there's millions more available in subsidies for poor and middle-income Texans, making this health insurance option more affordable than it's been in the past.

Here's what you need to know:

What is open enrollment, anyway?

Open enrollment is the time period during which Americans can pick a health insurance plan on the federal government marketplace. Most Americans — just under 50% — get health insurance through their jobs, according to census data. Others who qualify will get insurance through a public program, like Medicare or Medicaid. And about 5.9% nationwide will get coverage elsewhere, like purchasing a plan directly from the federal government's marketplace.

What's different this year

For some Americans, buying a marketplace plan will be more affordable this year because of expanded subsidies made available through the American Rescue Plan Act. A single person making between $12,880 and $19,320 can qualify for a plan with no monthly payments. For people making more than that, this open enrollment period also offers more subsidies and co-payments, according to the Kaiser Family Foundation.

Not everyone qualifies for help paying for health insurance. Undocumented immigrants, and Texans who make less than $12,880 a year do not qualify for help buying a marketplace plan.

How to get help

If you need help understanding the different plans available in Tarrant County, or determining whether a certain plan is accepted by your family doctor or will pay for a prescription, you can get help for free through what's known as "assisters." In Tarrant County, there are two health facilities with staff ready to help you pick a plan: North Texas Area Community Health Centers (NTACHC) and JPS Health Network. Both facilities will help you shop for a plan regardless of whether you are a patient.

Michelle Haynes, the director of enrollment and eligibility at JPS, said she and her colleagues won't tell a patient which plan to choose, but can help them identify plans that will cover their needs. But, she said, patients need to know what it is they prioritize in their health coverage.

"If a patient comes in and wants to make sure their diabetes medication is covered, we can research that and tell them which plans will cover that," Haynes said. "We need to know if you're looking for something special...so we can make sure we're guiding you toward a plan that fits your needs first."

If you have a chronic condition, if you take prescription medication, or if you use a specific doctor or hospital, you should check to make sure the plan you're choosing will cover the things you need, Haynes said.

The cost of plans vary by your income, what county you live, and whether you smoke.

Mary Lou Martinez, outreach and enrollment specialist with NTACHC, said she encouraged people to call and see what plans are available and what the costs might look like based on income.

"Once you do the application, it's not a commitment, but that would allow you to see what the options are," Martinez said.

Both Haynes and Martinez said they were seeing more people qualify for subsidies in buying health plans this year because of the increased subsidies available.

"And it's a blessing that we do have Marketplace coverage," Haynes said. "We have so many resources right now that can help people with their medical care. And it's important we use those."

At both JPS and NTACHC, people can also find out if they are qualified for other programs, like JPS Connection, the health network's discount program for county residents, or Medicaid.

Some adults might choose not to pick a health insurance plan, even if they're eligible. In 2017, Congress got rid of the financial penalty for people who decided to skip health insurance, meaning you won't have to pay a fee if you decide not to get insurance.

What to avoid

Shoppers should be careful, Martinez said, not to purchase plans that don't include a full set of benefits. All plans on HealthCare.gov must be "qualified health plans," meaning they have to offer a standard set of benefits in accordance with the Affordable Care Act. Some plans sold elsewhere might look cheaper and low monthly payments, she said, but actually provide very little coverage when you need it.

The Federal Communications Commission also advises people to be very cautious if they receive a phone call from an insurance company trying to sell an insurance plan, because it might be a scam.

Resources

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.

— JPS Health Network: Call JPS Enrollment and Eligibility at 817-702-1001.

You can find health insurance agents or brokers by visiting healthcare.gov and clicking on "find local help."

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