At Last: Answers About Picking Marketplace Health Insurance

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?

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 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.

So 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.)

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?”) 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 rules of the Affordable Care Act (ACA).

If 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 Sign Up?”)

If 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?”)

If 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 company.

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 information?

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 really isn’t?

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.

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Contacts: 

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


Marcus Cooper
phone: (512) 370-1382
cell: (512) 650-5336 
Marcus Cooper  

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. 

Last Updated On

March 14, 2018