What’s new on this year's Affordable Care Act marketplace for Houston?

 

© JOE BUGLEWICZ, STR / NYT

The 2021 Affordable Care Act exchange will bring a new insurance carrier to Houston while maintaining premium rates when open enrollment begins Nov. 1.

The 2021 Affordable Care Act exchange will bring a new insurance carrier to Houston while keeping most premiums around the same price as last year when open enrollment begins Sunday.

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In Harris County, residents can choose from 84 insurance plans. More people are expected to enroll in insurance plans offered through the exchange this year as the pandemic forced layoffs and the loss of job-sponsored insurance.

Friday Health Plans, based in Alamosa, Colo., joins five other carriers on the open exchange: Ambetter, Blue Cross Blue Shield of Texas, Community Health Choice, Molina, and Oscar.

Sal Gentile, co-founder of Friday Health Plans, said their plans are designed for individuals like gig contractors like rideshare drivers who want coverage but are classified as independent contractors rather than employees

“We’ve filed and seen the rate comparisons to all the other filings, and we are confident that our prices will be the first or second lowest price in both the bronze and silver category, and among the cheapest in the gold category,” he said.

Bronze plans have lower monthly premium costs with high deductibles, while gold plans have higher monthly premiums with lower deductibles. Silver plans are a balance between the two.

Gentile said he expects to enroll as many as 20,000 customers in their plans in Houston because of their pricing.

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Surrounding counties such Fort Bend and Montgomery counties don’t have Friday Health Plans as an option, but buyers can still compare and choose plans offered by several insurance carriers.

Prices aren’t very changing much from 2020 plans, insurers and analysts said. Statewide, the average price for the benchmark plan, the silver-level plan, has stayed flat.

That should be a relief for consumers in a year when many households are under financial stress because of the recession, said Stacey Pogue, a senior policy analyst at Every Texan, an Austin-based health policy think tank.

Consumers typically steer clear of the cheapest bronze plans, with most opting for silver plans that have moderate monthly premiums and deductibles. During open enrollment, though, many consumers revisit the marketplace to see if they can get a better deal on an insurance plan and save more money.

“Most people going into the marketplace are pretty price sensitive,” Pogue said. “People might be happy with their plan, but they’ll change year to year to keep that savings.”

Premium prices are down for the third year in a row nationwide, an 8 percent drop from 2018, according to the Centers for Medicare and Medicaid Services.

“You might think of it as the market stabilizing,” said Shara McClure, senior vice president of Texas health care delivery for Blue Cross and Blue Shield of Texas.

In the early years of the exchange, premium prices zigzagged across the charts as insurers struggled to project the demand was for individual insurance plans and adjust for rising health care costs. They spiked in 2016 and 2017, when health insurers such as Blue Cross Blue Shield of Texas and Community Health Choice imposed increases near 50 percent and larger insurers such as Aetna and Cigna pulled out of the Texas market, citing unsustainable losses while insuring people who were chronically sick.

Texas has the highest rate of uninsured residents in the nation, which has only risen higher with an estimated 1.2 million Texans losing employer-sponsored health coverage with their jobs during the pandemic-driven recession. As many as one in three residents could be without health coverage in 2020, according to the Kaiser Family Foundation, a San Francisco-based think tank.

Approximately 881,000 Texans qualified for subsidies for Affordable Care Act exchange plans during the pandemic because of the loss in income. If more households are eligible for reduced costs through subsidies, they’re more likely to purchase insurance plans.

Federal data shows that 1.1 million Texans purchased plans during open enrollment last year, about the same as the prior year.

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More brokers and agents are licensed to help people enroll in 2021 plans, according to the Centers for Medicare and Medicaid Services. More than 40,000 people are registered to assist with enrolling customers in exchange plans, an increase of 5,300 agents from the year prior.

A challenge to the Affordable Care Act will be heard by the Supreme Court Nov. 10, but any decision, not expected before June, is unlikely to affect whether 2021 health insurance policies, Pogue said.

McClure, the Blue Cross and Blue Shield executive, said people are especially interested in purchasing health coverage this year because they’re anxious about high medical costs if they contract COVID-19.

“They could feel like their health risk is a little bit higher than it might be in a normal year,” McClure said. “We’re hopeful that more people who are eligible for coverage take advantage.”

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