Window shopping for health care could mean serious savings

Published 8:12 am Sunday, November 1, 2015

By Jamie Dudensing, CEO, Texas Association of Health Plans

Earlier this year, the cost of health care returned for the first time in several years to the top of the list of financial concerns for Americans across the country. But trends also show that Texans and Americans are not sitting back and accepting higher prices but instead becoming savvy health care consumers who shop around for the best and most affordable health care coverage for themselves and their families. During the 2015 open enrollment period, more than half of consumers who re-enrolled on shopped around and compared plans, with half of those shopping selecting a new plan. Two-thirds of those who bought or switched to new plans said that price was the most important factor in their selection process.

In the coming weeks, Texans have an important opportunity to achieve significant health care savings. Under the Affordable Care Act (ACA), signed into law in 2010, there are now designated windows of time each year in which eligible Americans can enroll in a group health insurance plan or change their existing plan. For 2016, this window, called an open enrollment period, begins November 1, 2015, and continues through January 31, 2016.

During the open enrollment period, Texans can compare and contrast various health care plans to determine which plan best suits their individual needs and household budgets.

A variety of tools exist to help you understand the basics of health insurance and the most common terms you will encounter. One such tool is “The Health Care Law and You (2016)” produced by the Center for Health Care Guidance ( Individuals called navigators are also available to assist you in person, help you apply for health coverage, pick a plan, and enroll—free of charge. You can find a local navigator through the HHS web site (

Once you feel comfortable with the terminology, it’s time to compare and contrast individual health plans. New analysis from HHS found that for the 2015 open enrollment period, consumers who shopped around and switched plans within the same metal tier (bronze, silver, gold and platinum) saved an average of nearly $400 on their 2015 premiums after tax credits, as compared to those who stayed in their same plans.

Health care experts advise consumers to consider factors like their likely health expenses for the year, whether they can withstand high costs if they experience unexpected health care situations, and whether their existing providers are included in a specific plan’s network. Other important factors you will want to consider include your monthly premium cost, your copayment for various medical services, your annual deductible and whether or not you require prescription drug coverage.  Based on your household budget or your individual health care needs, you can select high or low-deductible plans. High-deductible plans typically have lower monthly premiums, but those with chronic conditions may opt for low-deductible plans due to the cost of regular doctor’s appointments and other services.

Based on your income level, you may be eligible for a federal subsidy. For example, as reported by Modern Healthcare, “a 27-year-old woman in Austin, Texas, with a $30,000 salary is eligible for a small monthly subsidy to lower her premium. She can choose from 64 different plans, with 52 of those being high-deductible options.” Subsidies in the form of premium assistance are available for consumers making 100% to 400% of the Federal Poverty Level (between $11,770-$46,680 for an individual, and between $23,850-$95,400 for a family of 4 in 2015).

Every plan, as required by the ACA, must fully cover what are known as Essential Health Benefits and include physical examinations, blood screening tests, mammograms and other preventive care services at no cost to the enrollee.

The Texas Association of Health Plans encourages every Texan to visit and explore options available this year. Even casual window-shopping may result in lower health care costs for you and your family. If you prefer to shop for plans by phone, call 1-800-318-2596.

The Texas Association of Health Plans (TAHP) is the statewide trade association representing private health insurers, health maintenance organizations, and other related health care entities operating in Texas. Our members provide health and supplemental benefits to Texans through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. TAHP advocates for public and private health care solutions that improve the affordability, access and accountability of health care for many Texans. As the voice for health plans in Texas, TAHP strives to increase public awareness about our members’ services, health care delivery benefits and contributions to communities across Texas.

Jamie Dudensing is CEO of Texas Association of Health Plans