Open enrollment launches Tuesday on HealthCare.gov, and the event has particular relevance for over half a million Texans.
That’s because their current insurers, Bright Healthcare and Friday Health Plans, are exiting the Texas exchange business at the end of December and are not offering plans for next year.
Customers can select a 2023 plan from a new insurer during open enrollment, which runs through Jan. 15. If they don’t pick a replacement, they’ll be automatically reenrolled in something similar.
“This is very important: They will not be without coverage in January,” said Jennifer Chumbley Hogue, an insurance broker in the Dallas area and an analyst for healthinsurance.org.
But she and other experts urged people to shop around: “Auto-enroll is never a good idea,” Hogue said.
Insurers often raise premiums and copayments, and they sometimes trim benefits, such as prescription coverage or doctors in the network. In addition, customers’ annual income and household living situations may change, and those factors affect federal subsidies used to offset monthly premiums and deductibles.
The upshot is that it usually pays to be a repeat shopper on HealthCare.gov, and the surprising good news is that most people have embraced the idea.
Nearly eight in 10 Texans renewing coverage for 2022 returned to the marketplace to update information and compare plans, said Stacey Pogue, senior policy analyst at Every Texan, an Austin nonprofit advocating for greater access to health care. Just 22% of Texas customers on HealthCare.gov were automatically reenrolled.
“It takes all this extra effort to update your information and pick the best plan, and it turns out that most people are doing that,” Pogue said.
Usually, it’s not because their insurer is leaving the state.
“People switch because they’re seeking the best deal or they want to keep their doctor” in the network, Pogue said. “Most people in the marketplace are really price sensitive so we see consumers changing plans every year.”
Bright and Friday did not announce their departures from Texas until early October, and experts attributed the decision to financial losses. Bright lost $432 million in the first six months of this year, and Friday said it would exit after proposing a 30% increase in premiums in Texas.
Friday entered the Dallas market in 2021 and Bright in 2022, and both captured significant market share by offering low-priced plans. Statewide, Bright had over 278,000 customers on the exchange this year and Friday had over 263,000, according to insurance industry data cited by Jeffrey Ingrum, CEO of the Baylor Scott & White Health Plan.
While those two companies departed, two big brand names returned to the exchange business in Dallas: Cigna Healthcare and Aetna CVS Health. With them, Dallas-area residents have eight companies offering 123 plans for next year many with zero premiums and low- or no-cost copays, depending on eligibility.
The number of enrollees in Obamacare has grown sharply — in large part because of expanded subsidies — but the business can still be tough. If a company does not have the right mix of healthy and sick people, health care costs will be too high and premiums too low, said Daniel Karnuta, a former health care executive who teaches at the University of Texas at Dallas.
“New upstart companies come in thinking they can play in the insurance market, but it’s complicated and actuarially difficult,” Karnuta said. “It’s a statistics game and you have to be really good at it.”
Baylor Scott & White has the lowest-priced silver plans in Dallas County for 2023, Pogue said. And it’s slated to get a lot of Bright and Friday customers — a total of 79,000, including over 55,000 who were on Bright silver plans in Dallas and Collin counties, Ingrum said.
Those customers will be assigned to Baylor Scott & White, and they’ll have the option of remaining or selecting a different plan.
Baylor boosted its customer service in preparation for an influx of business, Ingrum said, and some customers in Dallas and Collin counties will have access to the same providers they had previously — in addition to Baylor Scott & White’s network of doctors and facilities.
“We were already working with our network providers to ensure access to both in-person care and virtual care to meet those membership expectations,” Ingrum said in an email.
He’s hoping most newcomers will stay with Baylor: “Our network providers, our service personnel and our entire organization are excited to welcome these new members,” Ingrum said.
There’s been some churn among insurers on HealthCare.gov, peaking after Republicans came close to repealing the Affordable Care Act in 2017. That year, just three companies offered exchange plans in Dallas, down from seven insurers in 2016. Participants began returning in 2020, and many experts said the market has stabilized — politically and financially.
But the exits of Bright and Friday were surprising because they came less than a month before open enrollment. Their low-priced plans were the most popular among people getting help from local navigators, said Daniel Bouton, senior director of family and community health at United Way of Metropolitan Dallas.
In September, he said, leaders from Friday flew to Dallas to meet with local navigators about 2023.
“We set up training with them, and I met with them a couple of times just to understand their plans and what they were offering,” Bouton said.
A few weeks later, Friday pulled out of the exchange in Texas. Bouton said he isn’t worried because there are so many options on HealthCare.gov, including Baylor plans with in-network coverage for many of his clients’ current providers.
“Insurers come in, insurers go out, and we have no control over it,” Bouton said. “The best we can do is provide education and help people find a plan they’re comfortable with.”
