UPDATED: Oct. 24, 10:57 a.m.
As open enrollment approaches, Central Texas residents in the individual health marketplace will have fewer health insurance options and less time to enroll this year.
Open enrollment—the time of year when individuals can make changes to their current health insurance plan or enroll for the first time—begins Nov. 1 and ends Dec. 15.
With many changes coming to the marketplace this year—including health insurance options, prices and length of time to enroll—health care professionals such as Dr. Norman Chenven—founding CEO of Austin Regional Clinic—suggest patients take the time to compare their options before enrollment begins.
“The cost of health care has been a real challenge for everyone,” Chenven said. “We see health plans and employers trying different mechanisms to manage the cost, but that has resulted in some complex situations. It’s hard [for people]to make good decisions when you’re sick and need help.”
With the 45-day window, Texans have about half the time to pick a new health insurance plan than they did last year, when open enrollment lasted three months.
In addition to having less time, individuals in Central Texas have fewer options from which to choose this year, said Stacey Aikman, director of administrative operations and marketing for Vista360health, an Austin-based health insurance company.
“Last year the majority of health [insurance plan]options for individuals left the market in Central Texas,” Aikman said.
Both Aetna Life Insurance Co. and Cigna Health and Life Insurance Co. recently made a full withdrawal from the individual market in Texas and will not have any offerings in Central Texas for 2018, according to the Texas Department of Insurance.
The TDI will not have a complete list of 2018 carriers until the Centers for Medicare and Medicaid Services finalizes its list of approved plans, the department said. But residents can expect plans from at least Vista360health, Blue Cross Blue Shield Association of Texas and Sendero Health Plans Inc.
The remaining providers in Central Texas have submitted requests for 2018 rate hikes.
Vista360health requested a 13 percent rate increase, Blue Cross Blue Shield applied for a 24 percent increase and Sendero’s IdealCare requested a 25 percent increase, according to www.ratereview.healthcare.gov.
Chenven said ARC advises patients to check if their current primary care provider accepts the insurance they are considering and understand the benefits structure of a plan, such as which plans offer high premiums versus high copays.
Aikman said it is critical to check if the plan is qualified under the Affordable Care Act because uninsured residents or those using an unapproved plan could be penalized. This year penalties taken from income tax refunds were either 2.5 percent of income or $695 per adult and $347.50 per child, up to a maximum of $2,085. In 2018, the flat and maximum rates will adjust for inflation.
Editor’s note: This post has been updated for clarity.