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Community members get help navigating health insurance options

Community members get questions about health insurance answered at an enrollment event held at Sanitas Medical Center in Mesquite.

What Outreach Specialists Are Saying About Marketplace Enrollment

Job losses, resignations and early retirements triggered by the COVID-19 pandemic have put many people in the position of shopping for insurance from the individual marketplace, perhaps for the first time.

In Texas, more than 4 million adults younger than age 65 are uninsured, with about half of them qualifying for free or reduced-cost insurance premiums through marketplace coverage.

The outreach team for Blue Cross and Blue Shield of Texas (BCBSTX) is dedicated to educating consumers about their options during open enrollment. The team’s specialists recommend keeping some important factors in mind.

The open enrollment window is open

It’s time to start comparing plans. Consumers have until Jan. 15, 2022, to select coverage. Enrolling by Dec. 15 guarantees coverage will begin Jan. 1, 2022.

There’s a good chance you qualify for a subsidy

Nationally, an estimated 12 million uninsured people are eligible to buy coverage through the marketplace. With expanded subsidies under the 2021 American Rescue Act, most will qualify for free or reduced-cost monthly premiums, the Kaiser Family Foundation found.

At least 6 million uninsured people could get a $0 premium marketplace plan. And, according to the U.S. Department of Health and Human Services, 4 out of 5 people can find a plan costing no more than $10 a month.

Even people with incomes between 400% and 600% of the federal poverty level, who previously earned too much to qualify for subsidies, (up to $76,560 for a single person or $157,200 for a family of four) could save an average of $213 per month.

There’s more to health care costs than premiums

No matter how low the premiums, people may be tempted to underinsure themselves to reach $0 premiums, says Karen Travit, an outreach specialist with BCBSTX.

“They’re talking among themselves and their neighbors and questioning why they have to pay anything if someone else doesn’t,” she says. “We’re explaining the basics of health insurance and why people need to have coverage that fits their circumstances — or why they need to have coverage in the first place.”

Think about your provider network

There’s also more to a plan than its price tag. All plans don’t include the same doctors, clinics and hospitals. Do you like your doctors? Do you or your kids require ongoing medical care? Look for a plan that includes the doctors and hospitals you want in its provider network.

Many people struggle to understand how provider networks work or the difference between and HMO and PPO plan, says June Kim, an outreach specialist with BCBSTX.

“A lot of this work involves continuous education,” she says. “People believe insurance covers everything and every provider, no matter what plan they select.”

Accurately report your income

It makes sense people want to qualify for the lowest-possible premiums. But the Internal Revenue Service will expect them to make up the difference if they earn more than they claim when buying insurance.

People who get subsidies fill out special tax forms, and any income differences will be reflected in their tax payment or refund, says Natilea Henderson, an outreach specialist with BCBSTX.

Auto re-enrollment isn’t always in your best interest

Current marketplace members should take a fresh look at their plans and options before automatically re-enrolling, the team says. It’s important to check for changes in the provider network, drug coverage and premiums. 

“Every year people make a decision and they don’t think about it again,” says Denyse Maxey, a senior market delivery manager for BCBSTX. “We have to help them understand what they purchased and how it may have changed.”

Ask for help

Health care is complex. The BCBSTX outreach team offers free one-on-one assistance in English and Spanish to help consumers understand plan options and answer questions. “I really want people to look at us a resource,” Henderson says. 



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