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Texas health insurance quotes  Texas Health Reform Center 2016 ACA Enrollment


We’re almost there!

Open Enrollment for the Affordable Care Act (ACA) begins November 1.

So knowing how enrollment works – and making it work for your needs – is very important.

At Stateside, the last two enrollments have taught us a lot about making enrollment as easy as possible.

This year’s enrollment will be huge!

Many more people will enroll this year than ever. Why?

People are catching on.

In Texas, we’re seeing more people interested in the ACA because they’re beginning to see the value of having health insurance.

They also want to avoid the personal responsibility penalty – the yearly fine charged to people without health insurance.

This penalty has gone up each year.

For 2016, it’s the higher of either 2.5% of their yearly household income or $695 for each adult or $347.50 for each child.

If that wasn’t enough: For 2016, Blue Cross Blue Shield and Humana won’t be offering their Preferred Provider Organization (PPO) networks – for Off Market (no subsidy) and On Market (subsidy) plans.

Both insurance companies have said their claims costs for these plans were more than the premiums they charged, making it impossible to keep offering them.

Now, people with these policies must review their choices and decide what policy meets their needs best.

Something called “split coverage” will also cause enrollment to go up.

Split coverage happens when a family decides to have several policies instead of one policy for the whole family.

They do it to reduce their overall costs.

Let’s say the family had been paying for a Silver plan to take care of prescription needs for one family member. With split coverage, they can have the less expensive Bronze plan for the family and a Silver plan for the person needing the prescription benefits of the Silver plan.

New: Metallic Supplement Plans mean help is on the way

As premiums keep going up, people looking to trim their costs might move from Silver plans to the less expensive Bronze plans.

Nice move as far as premiums go, but the deductible going from $3,000 to $5,000 could make people pretty nervous. Metallic Supplements can help.

Metallic Supplements are stand-alone insurance policies that work along with an ACA plan, providing cash payments for major conditions such as cancer and heart attack or stroke.

Once a condition is diagnosed, the insurance company makes a $10,000 cash payment directly to the insured person.

This payment could make up for the Bronze plan’s $5,000 deductible. What’s more, coverage can be added for critical illnesses, hospital stays or accident claims.

Metallic Supplement plans are more cost effective than the lower deductible Silver plans.

For example, a single adult 40 to 44 years old would pay $51 a month for the Metallic Supplement with a $10,000 benefit compared to an additional $85 a month to move from a Bronze plan with a $5,000 deductible to a Silver plan with a $3,000 deductible.

A family of three would pay an extra $146 a month to go from Bronze to Silver, but only $56 a month for a Metallic Supplement.

More choices to make…

We all know that past Open Enrollments were complicated.

People had to learn about the ACA plans, enrollment deadlines and how subsidies would affect their final premiums. This Open Enrollment will be even more complicated because of what we’ve already talked about – and more.

Physician network changes

This year, you’ll need to check out your physician network very carefully.

It’s not like the good old days when doctors were in more than one network.

Because insurance companies like Blue Cross Blue Shield and Humana have gone to HMO networks with many limitations, you shouldn’t change plans without carefully researching your doctors’ network participation. And please don’t rely on your doctor’s office staff to confirm the doctor’s network.

Often the staff doesn’t know the exact networks, or they don’t know if the doctor has signed new contracts with the insurance companies.

Best Practice: Verify network participation with us!

At Stateside Insurance Services, we have access to the online provider search engines to identify the exact network participation for your provider.

What’s more we can research all five major carriers serving the Texas market.

Prescription Formulary changes

But wait. There’s more!

This year, prescription formularies will be getting more attention. A prescription formulary is a list of drugs insurance companies have found to be most effective in treating a condition.

Deciding to include a drug in their formulary is based on the scientific research and information the companies get from the drug manufacturers.

Formularies include generic drugs – and must have at least one brand-name option for each drug class.

The size of the formulary and the specific drugs included changes with each Open Enrollment.

The prescription formulary is one of the few areas an insurance company can link directly to their plan’s financial performance.

If you take any prescriptions, especially brand- name drugs, always check a plan’s formulary before enrolling. Often, a higher premium plan costs less than another plan because the prescription benefit is better for a specific drug.

This is especially true for brand-name drugs.

Deadlines, Deadlines, Deadlines. Dates to remember…

Deadlines can get you every time.

This year, pay special attention to the ACA enrollment deadlines, especially around the 15th of the month.

Beginning in November 2015 the 15th of each month is the cutoff for insurance to take effect on the 1st of the next month. So if you submit your application on or after December 16, 2015 your policy won’t take effect until February 1, 2016.

An application submitted on or after January 16, 2016 will be assigned March 1, 2016 as the effective date of coverage.

Getting ahead of the game:

Other dates to remember: December 15, 2015 and January 31, 2016.

December 15 is the last day for your insurance to be effective on January 1, 2016. So no surprise that it’s been one of the busiest enrollment days. And obviously, January 31, 2016 will be huge because it’s the last day of Open Enrollment for 2016.

More people will enroll this year than ever.

Which means the ACA website could be jammed or go down, especially close to the deadlines. At Stateside, we encourage our clients to enroll at least three days before any key deadline.

The past two Open Enrollments have included deadline extensions.

They were allowed because issues with the online Health Insurance Marketplace kept many people from finishing the application process. At this point it’s unknown if an extension will be allowed for this Open Enrollment. But if the online Health Insurance Marketplace works more smoothly, the possibility of an extension will be less than in previous years.

News Flash: Streamlined subsidy applications this year

A major issue during the past two Open Enrollments was how long it took to complete a subsidy application – typically 45 minutes and up to 2 hours. These delays were in addition to the website issues people had with the ACA marketplace.

At Stateside, we have a possible solution to the headaches people experienced.

We now subscribe to an online tool that will allow subsidy applications to be completed in less than 15 minutes – and in many cases submitted in under 10 minutes.

And for a big plus, the reduced enrollment time includes not only the subsidy application but also the policy application directly to the insurance company!

 This tool has a user friendly interface with and provides an easy process to get a quick subsidy decision and for choosing a plan for submission to the carrier. What’s more, it works more efficiently than and eliminates the cumbersome identity verification process.

Check it out: Online ACA Subsidy Application.


At Stateside, we’ve monitored the Affordable Care Act since it was signed into law in 2010.

We have studied and researched the ACA as the rules and regulations were being promulgated. And since the beginning, our Stateside Team has been certified with the Health Insurance Marketplace for every Open Enrollment period.

If you have questions about subsidy eligibility, plan options, carriers, premiums or enrollment, contact us for straightforward advice about the upcoming Open Enrollment.

Contact Stateside by email at  or call us at (866) 444-3332.


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