Texas utilizes the federally run exchange at HealthCare.gov, and the state has adopted a very hands-off approach with regards to implementing the ACA. Texas has not expanded Medicaid and is one of just three states that leaves the rate review process for ACA-compliant plans to CMS. (The state does also review filings to make sure they’re compliant with Texas law.)
Texas hasn’t expanded Medicaid and has an exceedingly hands-off approach to implementing the ACA.
Texas is also leading an 18-state lawsuit that disputes the legality of the ACA now that the individual mandate penalty has been revoked. The Supreme Court will hear oral discussions in the case during the term that starts in the fall of 2020.
But Texas also has one of the most considerable exchange enrollments in the country, with 1,116,293 people enrolling in private plans through the Texas exchange during the open enrollment period for 2020 coverage. The state has a vast population, many of whom were uninsured pre-ACA. Only two states — Texas and California — have higher enrollment in their exchanges (not counting Medicaid) than Texas. And Texas is one of only a handful of HealthCare.gov states where enrollment increased from the Texas health insurance marketplace 2019 to Texas health insurance marketplace 2020.
Rates increased sharply in 2018, and insurers started adding cost-sharing reductions (CSR) to silver plan rates, resulting in unusually large premium subsidies (based on the cost of silver plans) in 2018. However, for the Texas health insurance marketplace 2019, the average rate increase was much more modest, at just over 2 percent. And for Texas health insurance marketplace 2020, average rates decreased slightly. The cost of CSR is still being added to silver plan rates, so subsidies are still disproportionately large in Texas.
According to US Census Bureau data, Texas had the highest uninsured rate in 2013 at 22.1 percent. And although the state’s 17.7 percent uninsured rate in 2018 was still the highest in the country, a substantial number of Texas residents had obtained health coverage since the ACA was implemented. However, the number of people gaining coverage would be far higher if Texas were to accept federal funding to expand Medicaid under the ACA.
When is Open Enrollment for 2021 Health Insurance in Texas?
Open enrollment for 2021 health plans in Texas will run from November 1, 2020, to December 15, 2020. Outside of that window, residents need qualifying events to enroll or make changes to their coverage. Loss of other minimum essential coverage is a qualifying event, so people losing employer-sponsored coverage as a result of the COVID-19 pandemic can enroll in a new plan in the individual market, as long as they do so within 60 days of losing coverage.
Which Insurers Offer 2020 Coverage in the Texas Marketplace?
Texas has various companies that are going into the health insurance marketplace with different plans.
As of 2020, eight insurers offer exchange plans in Texas, plus two that offer ACA-compliant individual market plans outside the exchange. For 2021, it’s expected that there will be ten insurers offering plans in the exchange:
Friday Health Plan will join the marketplace in Texas, and Scott & White Health Plan, which only provides plans outside the exchange in 2020, will join the exchange in north Texas.
Does Texas Protect Consumers from Surprise Balance Billing?
Surprise balance billing is a problem that the federal regulations have not yet adequately addressed (although Congress was close to an agreement on this as of late 2019), so states have begun handling it themselves. The situation occurs when a patient uses an out-of-network provider, but not by choice. It can be an emergency in which the closest hospital is out-of-network, or it can be a circumstance in which the patient goes to an in-network facility but is treated by out-of-network providers. This might be an assistant surgeon, anesthesiologist, radiologist, laboratory, durable medical equipment supplier, etc. And while the patient did their due diligence in terms of finding an in-network facility, it can be challenging — or next to impossible — to ensure that every provider who works with the patient will also be in the patient’s insurance network.
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