Changes ahead for East Texans during ACA open enrollment

 

The annual open enrollment period for the Affordable Care Act's marketplace runs through the end of January, but this third year of open enrollment is being met with frustration from both consumers and navigators helping to find options for the uninsured.

Lisa Williams, a navigator who works with residents in Smith, Rains, Wood, Van Zandt and Henderson counties, said some people already covered through the ACA will have to find different options.

Blue Cross Blue Shield had been the only insurer providing coverage through the marketplace in East Texas counties. This summer, the insurer announced that it would drop its PPO plan in 2016, with administrators stating the company lost $400 million in the marketplace in 2014.

About 367,000 Texans will lose their PPO coverage and only have an HMO plan to choose, which limits the network of physicians and hospitals.

In addition, BCBS is set to hike rates for its Blue Advantage HMO individual plan by 19.97 percent.

"There are going to be some bumps," Ms. Williams said. "It's back to the drawing board for some people in 2016."

But there is at least one other option, she said.

United HealthCare will now offer an exclusive provider organization plan, or EPO coverage, through the marketplace for residents in Smith, Rusk, Harrison, Gregg and Upshur counties. Consumers who use this plan would still have a limited network of doctors and hospitals but may see more cost savings than a PPO, Ms. Williams said.

Another change people can expect is the penalty for not having insurance coverage. It will more than double in 2016, jumping to $695 per adult, or 2.5 percent of household income, from $325, or 2 percent of income last year.

To have health insurance coverage by Jan. 1, people would need to sign up or make changes by Dec. 15. To begin coverage on Feb. 1, they'd need to sign up by Jan. 15.

Open enrollment ends Jan. 31, and for any enrollment occurring between Jan. 16 and Jan. 31, coverage would take effect March 1. Some may qualify for a special enrollment period. See healthcare.gov for more information.

OUTREACH

Navigators Ms. Williams and Lauren Parlow cover Smith County, Rains, Van Zandt, Wood and Henderson counties. They received funding through the East Texas Behavioral Healthcare Network to provide education and enrollment assistance to the uninsured.

Special Health Resources for Texas - with clinics in Tyler, Longview, Paris and Texarkana - received a grant the first two years through the United Way of Tarrant County. Five navigators are now funded by the Community Council of Greater Dallas, which covers 23 East Texas counties.

Getting to people who may qualify for a tax credit through the marketplace and explaining how it works has been a challenge for navigators. This includes information about when to sign up, subsidies they may receive based on income and household size and how to select a plan for their health care needs.

"There's still a lot of confusion about how it works," Clyde Clubb, lead navigator with SHRT, said. "It's really complex for people who have never had insurance."

Navigators like Sam Conde, reaches out to people at health fairs, churches, barber shops and laundry mats.

"I try to connect with the community to be able to do outreach so they can come into the office," he said. "Most people do not have the correct information."

For more details or to sign up for health insurance call SHRT at 903-247-1078. Ms. Williams said she and Ms. Parlow are available via appointments by calling 903-535-7303 or 903-535-7310.

Individuals also may find help enrolling through a certified insurance agent.

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