We have some updates on health insurance in Texas that we thought would be worth talking about this month. As you may or may not know, Open Enrollment for health insurance runs from November 1st- December 15th, and that will stay the same for the 2021 enrollment year.
When presented with ACA health insurance options here in Texas, many folks are surprised with how little competition exists in certain zip codes, such as in Guadalupe County for example. There, only one ACA carrier exists (Blue Cross Blue Shield of Texas). So if someone is not fond of the HMO plans that BCBS only provides, they may be out of luck.
The good news is that we recently learned how two new carriers plan to enter the 2021 ACA market in Texas: Friday Health Plans and Scott & White Health Plan, bringing the total carriers to ten. This in our opinion is great to hear, because more competition will force the existing insurers to align their premiums and benefits accordingly, in order to remain competitive. In addition, expansion should be occurring with existing carriers presently in Texas, such as from Molina Healthcare for example.
One area of recent healthcare reform that many Texans may not know about, is surprise balance billing. This has been a focus on the state level, but not federally as of now. This is when a patient uses an out-of-network provider, but not by choice. For example someone may have an emergency and the nearest hospital is out-of-network or the patient goes to an in-network facility but is treated by out-of-network providers. Many times, we wonder if our providers are in-network or not when they perform work on us. This law prohibits an out-of-network provider from billing the patient in excess of the patient’s regular cost-sharing obligations (ie. copays) and instead requires the provider and insurance company to enter into mediation or arbitration (overseen by state regulations) to come to some sort of payment agreement, without the patient being stuck in the middle of a dispute. Good news right?
Overall, health insurance in Texas and frankly the country is continuously evolving and it is our job here at The Harrin Group to keep you informed of what’s happening, so we can better assist the greater community. If we can be of service to you or your family, please reach out to us for a free analysis of your situation.
For more on the relatively new Texas healthcare law, see below ⇓
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Sources: Healthinsurance.org, Friday Health Plans, Scott & White Health Plan, WFAA ABC 8 News