How to get help choosing an insurance plan on HealthCare.gov

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Americans can buy insurance through Jan. 15 at healthcare.gov.

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Nearly one in four non-elderly adults in Tarrant County lacked health insurance in 2018, according to county health department estimates.

Although many Texans obtain health insurance through their work, some employers do not offer an employer-sponsored plan. And in Texas, only a relatively small number of adults are eligible for the Medicaid public insurance program.

But for the next two months, Americans have another option for getting health coverage. Americans can buy insurance through Jan. 15 at healthcare.gov. And this year, millions more grants are available for poor and middle-income Texans, making this health insurance option more affordable than it has been in the past.

Here’s what you need to know:

What is open registration, anyway?

Open enrollment is the period during which Americans can choose a health insurance plan in the federal government market. Most Americans — just under 50% — get health insurance through their jobs, according to census data. Other eligible people will get insurance through a public program, such as Medicare or Medicaid. And about 5.9% nationwide will obtain coverage elsewhere, such as purchasing a plan directly from the federal government market.

What is different this year

For some Americans, purchasing a market plan will be more affordable this year due to increased subsidies made available through the American Rescue Plan Act. A single person earning between $12,880 and $19,320 may qualify for a plan with no monthly payments. For people earning more than that, this open enrollment period also offers more grants and copayments, according to the Kaiser Family Foundation.

Not everyone is entitled to help paying for health insurance. Undocumented immigrants and Texans who earn less than $12,880 a year are not eligible for assistance to purchase a market plan.

How to get help

If you need help understanding the different plans available in Tarrant County, or determining if a certain plan is accepted by your family doctor or will pay for a prescription, you can get free help through of what are called “assistants”. In Tarrant County, there are two health facilities whose staff are ready to help you choose a plan: North Texas Area Community Health Centers (NTACHC) and JPS Health Network. Both facilities will help you purchase a plan whether or not you are a patient.

Michelle Haynes, 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 they prioritize in their health coverage.

“If a patient comes in and wants to make sure their diabetes medications are covered, we can research and tell them what plans will cover that,” Haynes said. “We need to know if you’re looking for something special…so we can make sure we guide you to a plan that meets your needs first.”

If you have a chronic condition, take prescription medications, or go to a specific doctor or hospital, you need to check that the plan you choose will cover the things you need, Haynes said. .

The cost of the plans varies depending on your income, the county you live in, and whether or not you smoke.

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

“Once you’ve made the request, it’s not a commitment, but it would allow you to see what the options are,” Martinez said.

Both Haynes and Martinez said they are seeing more people qualify for subsidies when purchasing health plans this year due to the increase in subsidies available.

“And it’s a blessing that we have Marketplace coverage,” Haynes said. “We have so many resources right now that can help people with their medical care. And it is important that we use them.

At JPS and NTACHC, people can also find out if they qualify for other programs, such as JPS Connection, the Health Network Discount Program for County Residents, or Medicaid.

Some adults may choose not to choose a health insurance plan, even if they are eligible for it. In 2017, Congress removed 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 buy insurance.

What to avoid

Buyers should be careful, Martinez said, not to buy plans that don’t include a comprehensive set of benefits. All plans on HealthCare.gov must be “qualified health plans,” which means they must offer a standard set of benefits under the Affordable Care Act. Some plans sold elsewhere may seem cheaper and have low monthly payments, she said, but actually offer very little coverage when you need it.

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

Resources

The North Texas Area Community Health Centers and the JPS Health Network can help you enroll in a market insurance plan.

  • North Texas Area Community Health Centers: Call 817-625-4254 and say you need help applying for market 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 “find local help.”

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Ciara McCarthy covers health and wellness as part of Star-Telegram’s Crossroads Lab. The position is funded with assistance from the Morris Foundation. She came to Fort Worth after three years in Victoria, Texas, where she worked at the Victoria Advocate. Ciara is dedicated to providing people and communities with the information they need to make decisions about their lives and well-being. Please contact us with your questions about public health or the health care system. Email cmccarthy@star-telegram.com or call or text 817-203-4391.

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