Jan. 13, 2015
Purchasing and using health insurance
is confusing to most everyone. As Texans choose their health insurance coverage
from the federal marketplace, “Hey Doc” is here to help. Since 2013, the Texas
Medical Association’s (TMA’s) “Hey, Doc” educational campaign has tried to
clear the confusion about buying and using health insurance. This week: If
insurance is mandated by the government, how
do you know if the plan you pick is OK? And how many plan options do consumers have? For that matter, how do you pick a plan? Can you keep your current plan? Read
on, for answers.
Hey, Doc, who can sell me
insurance in the marketplace?
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.”
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
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?
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 enter a few pieces of information, like your family size and where you
live, you can see and compare different plans and price estimates in your area.
You won’t get a final quote until you actually fill out an application.
far in Texas, 14 different
insurance companies are participating in the marketplace, selling more than 100 different
plans across the state. Again, your choices will depend mostly
on where you live. Some areas of the state, especially rural areas, might have
fewer insurance options than others. See how many plan choices you have on this map.
(Of the 254 counties in Texas, 60 had only one health insurer providing
benefits through the marketplace when open enrollment for 2015 began in
November 2014. Ninety-eight counties had just two insurers offering coverage.)
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?”) Healthcare.gov and BeCoveredTexas.org also have some
Can I keep the plan I have
likely, yes. You can keep the plan you have now as long as it meets the rules
of the Affordable Care Act (ACA).
you have a plan that you bought through the marketplace for 2014, you can renew
it, or enroll in a different one, during open enrollment. (See “How Do I Renew My Marketplace Plan?”
and “When Can I
you have your own insurance or a job-based plan that existed before the health
reform law was passed in 2010 — a so-called “grandfathered” plan — it is
possible that nothing needs to change. Check with your insurance company or
employer to find out. (See “What If I Have Insurance Through
My Work or Family?”)
your insurer renewed an older, nongrandfathered policy that doesn’t meet the
ACA requirements, you can most likely keep it for 2015. Otherwise, you will
have to buy a new plan that complies with the law. Check with your insurance
See each week’s “Hey, Doc”
Q&A and a lot more at texmed.org/Heydoc as well as in TMA’s patient
blog at MeAndMyDoctor.com. And TMA produced
“Hey, Doc” videos to help people understand how to navigate the marketplace.
TMA’s “Hey, Doc” content
schedule for the next few weeks:
Jan. 21: Who will take care
of me? What are the networks? How do I pick a doctor? Where can I find this
Jan. 28: Can I keep my
doctor or hospital when I sign up? How do I find out if my doctor is on my
insurance plan’s list? What should I do if I thought my doctor was included but
Feb. 4: Why is it important
that I pay my insurance premium on time? How do I know what kind of coverage I
have and if I can use my insurance?
TMA is the largest state medical society in the nation, representing more than 48,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
phone: (512) 370-1381
cell: (512) 656-7320
phone: (512) 370-1382
cell: (512) 650-5336
Click here to follow TMA on Twitter. Or visit TMA on Facebook.
Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.