By Now that open enrollment has officially kicked off, it is time for Texans to research their plan options for 2018. Texas has the third highest exchange enrollment in the country (behind FL and CA) with 1,227,290 Texans enrolling through the health insurance marketplace. And 88% of Texas marketplace participants receive premium subsidies that reduce average premiums from $404/month to $71/month.
At Take Command Health, we want to offer you a hand in selecting the best individual health insurance in Texas. Arming yourself with the most up-to-date information is incredibly valuable—as you know, knowledge is power.
What’s different this year
Since Trump took office in January, he has been promising to repeal and replace the Affordable Care Act (also known as Obamacare). Congress has not been able to pass a piece of legislation that replaces the ACA so it is still the law of the land. Which means you still need to have health insurance coverage or pay a penalty through your taxes. The penalty is calculated two ways: 2.5% of household income or per person fee ($695/ adult and $347.50. child). You pay whichever is higher!
What Trump has been able to do is reduce the open enrollment period by six weeks. The open enrollment season for 2018 coverage is Nov 1- Dec 15, 2017. He also reduced funding for the marketplace which means there will be less advertising and awareness campaigns about the shorter enrollment window this year. The government health insurance marketplace, healthcare.gov, will also have planned shutdowns this year during open enrollment, making it difficult for consumers to research and purchase plans. The site will be down on Sundays from 12am-12pm (Except Dec 10) during open enrollment and overnight Nov. 1.
Insurers Leaving the Texas Market
Humana and Prominence are leaving the market in 2018. Currently, Humana is in 10 counties clustered in Corpus Christi, San Antonio and Waco. If you are in a county currently offering Humana, don’t panic! Christus and Blue Cross Blue Shield Texas are remaining in your counties, so you still have good options.
Prominence offered plans in 11 counties in 2017 mostly in areas with low populations, although Amarillo and McAllen were also in their coverage area.
With Humana and Prominence exiting, 8 insurers now remain in Texas on the individual marketplace for 2018, but most counties will only be covered by one or two insurers – which is a trend we are seeing nationwide unfortunately.
Plan Types: HMO, PPO, EPO
HMO, PPO, EPO, what do these network types mean? It sounds confusing, but it mainly comes down to a few key points that distinguish these network types. Here’s an overview:
An HMO (or “health maintenance organization”) is generally the most affordable, but least flexible network type. Here a few key concepts of a HMO:
- You are required to select a primary care physician (or the insurance company can assign one for you) who is your first-stop for health needs. You will need a referral from your primary care physician to see a specialist.
- If you choose to see a doctor outside of the network or without a referral, you will generally have to pay all costs out-of-pocket unless it is a true medical emergency or you have no other options.
- The physician network is local.
A PPO (or “preferred provider organization”) is generally the most flexible, yet most expensive network type. Here a few key concepts of a PPO:
- You do not need to select a primary care physician and you do not need referrals to see a specialist.
- If you see an in-network provider, you will only be responsible for paying a portion of the bill (based on your plan’s coverage structure).
- If you choose to see a doctor who is outside the preferred network, you will generally have to pay a larger portion of the bill than you would for an in-network provider.
- You will have access to out-of-state providers that are considered in-network.
An EPO (or “exclusive provider network”) is a hybrid of a HMO and a PPO. Here a few key concepts of an EPO:
- EPOs are more flexible than an HMO, and are typically less expensive than a PPO.
- Like a PPO, you do not need a referral to get care from a specialist.
- Like an HMO, you are responsible for paying out-of-pocket if you seek care from a doctor outside your plan’s network.
Insurers participating in the 2018 Texas market
There are many insurance options available in Texas this year and coverage varies by county. All the plans offered on the Texas exchange can also be found off the exchange as well for individuals. If you are eligible for a tax credit, purchasing an on-exchange plan is the only way to utilize it.
Use TakeCommandHealth.com to estimate your tax credit, search for your doctors, and compare on-exchange and off-exchange options in your area.
Ambetter (Celtic): EPO
Ambetter covered 32 Texas counties in 2017 and will add 9 counties to their coverage area in 2018. Ambetter coverage is mainly centered around the metropolitan areas of Dallas, Austin, and Houston. Ambetter had 187,155 participants in 2017 and plans to have premium increases around 47.7% for 2018.
Blue Cross Blue Shield of Texas: HMO Statewide
Blue Cross Blue Shield of Texas remains committed to the Texas marketplace. They offered plans statewide in 2017 and will continue the coverage statewide in 2018. Blue Cross has 389,766 enrollees in 2017 and plans to have premium increases of 20.43% in 2018.
CHRISTUS Health: HMO
Christus Health plans will be available in 25 Texas counties in 2018. They have 25,000 participants in 2017. The average rate increases will vary from 33.7%-71% depending on plan type. The on-exchange silver plans will have the largest average rate increase at 71%, while the rest of their plans will average between 33-58%.
Community Health Choice: HMO
Community Health Choice will be available in 10 Texas counties. They will have premium increases around 49% for 2018. Community Health Choice offers members a 10 percent discount on their premiums if they complete a Health Risk Assessment. To get the discount for 2018, you have to complete your Health Risk Assessment before the end of January 2018.
FirstCare (SHA): HMO
FirstCare will cover 109 Texas counties in 2018 and is expecting average rate increases of 27.74%. Currently, FirstCare has 19,250 members.
IdealCare (Sendero): HMO
For 2018, Sendero will have coverage in 8 counties in Central Texas: Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, Williamson. Sendero’s plans have the most competitive pricing in the area and premium increases are expected to hover around 47.2%. Sendero projects their 2018 enrollment to be 456,000—they are definitely a key player in this market!
Molina: HMO
Molina will continue their coverage in the 9 counties they are currently in: Cameron, Collin, Dallas, El Paso, Harris, Hidalgo, Jefferson, Starr, and Webb. Molina plans to have 40.67% premium increases. They currently have 251,266 members but are projecting a drop in members in 2018 to 205,444 due to decisions to not market their plans outside of the exchange.
Oscar: EPO
Oscar will have plans available in 9 Texas counties this year, but is splitting where they can be found. Oscar plans available both on and off exchange will be found in San Antonio and Austin counties: Bexar, Comal, Hays, Travis, and Williamson. Dallasites will continue to find Oscar plans only available off the exchange in: Collin, Dallas, Rockwall, and Tarrant counties. Oscar has 22,846 members and plans premium increases between 26-44.7%.
Off-exchange only
Off exchange plans tend to be a little harder and more time consuming for individuals to find—that’s why Take Command Health’s online tool makes it easy to compare all the plans side by side! If you are looking for that elusive PPO plan, you will only be able to find it off the exchange through Medishare.
Scott and White: EPO or HMO
Scott and White is offering two types of plans: EPO or HMO. The EPO is available in 55 Texas counties, while the HMO is available in 61 counties.
Vista Health Plan: HMO
Vista HMO has a relatively small coverage area. Limited to 4 Texas counties: Bastrop, Hays, Travis, and Williamson.
Medishare: PPO (faith-based)
Faith-based Medi-Share has a state-wide PPO network available in 2018 managed by PHCS (Private Healthcare Systems, now owned by Multiplan). It’s smaller than some of the PPO networks in the past, but it does provide flexibility to see your doctors and will cover out-of-network expenses as long as it meets Medi-Share’s faith-based guidelines. Medi-Share won’t be for everyone, but is a worthy option to consider if it fits your personal convictions and lifestyle. Make sure to check out our Medi-Share review and compare it to other major medical plans on our website before you enroll.
Next Steps: What’s my best option?
Hunting down and comparing all of these options for individual health insurance in Texas can feel overwhelming. However, at TakeCommandHealth.com we help you compare all of your options side-by-side including off-exchange plans, marketplace plans, and faith-based options. You can use our award-winning tools to search for your doctors, check your prescriptions, and even simulate conditions and health needs to make sure you get the most of for your money. A few other updates we’d like to tell you about:
- We’ve expanded the capabilities of our doctor search tool to search doctor networks from all of the plans above (no matter if the plan is off-exchange, on the marketplace, or faith-based).
- We’ve negotiated some pretty awesome deals for our members. Call a doctor 24/7 for $0, medical bill negotiation support, dental, vision, and pharmacy discounts, etc. These really help save money with some of the higher deductible plans.
- We’re pretty confident we have the biggest, most complete line-up of plans in Texas this year.
- We’ve put together a bigger support team ready to help you tackle any issue. You can get started by chatting with us on our website or emailing us at support@takecommandhealth.com.
Please visit our website and we’ll walk you through your options. Our goal is to help you get the most out of your money and find the plan that really works for you and your family. Remember you have until Dec 15th to select a plan that starts Jan 1st, 2018.
