What Kind of Choice Do I Have in the Marketplace?

Oct. 21, 2013

We're more than two weeks into the new health insurance marketplace. Most people need to buy coverage before Jan. 1 or pay a penalty. So far in Texas, there are about a dozen different insurance companies participating in the marketplace, selling roughly 100 different plans across the state.

In some counties, insurer choices is quite limited. Of the 254 counties in Texas, 76 had only one health insurer providing benefits through the marketplace when it opened in October. One hundred-eleven counties had just two insurers offering coverage. Some areas of the state, especially rural areas, might have fewer insurance options than others. TMA's "Hey, Doc" campaign aims to help Texans understand how they can buy coverage and where they find it. Check out the Q&A below.

TMA's sixth week of "Hey, Doc" education programming

Who can sell me insurance through the marketplace?

In Texas, you can get to the health insurance marketplace through Healthcare.gov, and that's where you can find out if you can get help paying for your insurance. To sell insurance in the marketplace, insurance companies must first get the government's seal of approval on their plans to become what's called a "qualified health plan." That means they agree to follow the marketplace rules, like providing a specific level of benefits, limiting the amount you have to spend out of your own pocket, and having networks with enough doctors, hospitals, and other health care providers. You can see a list of approved health plans in Texas at Healthcare.gov, where you can buy your insurance directly. You can also get help with enrollment from a certified navigator or counselor, or a licensed insurance agent or broker approved by the government.

Remember, there is no charge to use Healthcare.gov or enroll in health plans through the marketplace. Federal and state authorities have warned about scams using phony websites, charges, and emails or phone calls, so know what you are buying and from whom you are buying it.

How do I pick a plan? How many plans can I pick from?

To pick a plan, visit Healthcare.gov, where you'll fill out an application to see a list of insurance companies and plans participating in your area. Your choices will depend mostly on where you live and the type of plan you want. Keep in mind that one insurance company might sell a bunch of different plans with different levels of coverage and prices. Once you fill out an application, you can see and compare different plans and prices.

That might seem like a lot of information to go through. But there are some things you can do ahead of time to figure out what kind of insurance you need. (See "How can I get ready to sign up?" from "Hey, Doc.") Healthcare.gov and BeCoveredTexas.org also have some helpful checklists.

Can I keep the plan I have now?

Most likely, yes. You can keep the plan you have now as long as it meets the new rules under the Affordable Care Act (ACA). If you have your own insurance or a job-based plan that existed before the health reform law was passed in 2010, it is possible that nothing needs to change. Check with your insurance company or employer to find out. (See "If I have insurance through my work or my spouse or my parents, do I have to give that up and buy insurance through the marketplace?" from "Hey Doc.")

Note to media: Please feel free to use the content in its entirety or as the basis for a story. TMA physician experts are available to answer your questions. Also, every Wednesday, TMA will post a new video featuring TMA Board of Trustees Chair Carlos "Hey Doc" Cardenas, MD. Check out TMA's first four videos, and a lot more information atMeAndMyDoctor.com andHeyDoc.texmed.org.

Below is TMA's "Hey, Doc" upcoming content schedule through Nov. 30, 2013.

Week of Oct. 28: What is covered by this insurance?

Week of Nov. 4: What different kinds of insurance can I buy?  What is "catastrophic insurance"?

Week of Nov. 11: What will it cost me to buy this insurance?

Week of Nov. 18: What are the subsidies? Who gets a subsidy? How do I apply for a subsidy?

TMA is the largest state medical society in the nation, representing more than 47,000 physician and medical student members. It is located in Austin and has 112 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans. 


Contact: Pam Udall
phone:(512) 370-1382
cell: (512) 413-6807

Pam Udall  

Contact: Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320

Brent Annear  

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Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.