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Open enrollment for health care coverage this year comes with a change

Many Texas families who previously didn’t qualify for coverage under the Affordable Care Act may benefit from a new rule

DALLAS — Texas has more uninsured people than any other state. But since November 1st, some of those Texans without insurance have been signing up for health plans in the HealthCare.Gov Marketplace created by the Affordable Care Act. For those who get their coverage that way, there are some important considerations and a big change this year.

In years past, if someone’s employer offered insurance, the government only calculated whether coverage for the employee was “affordable.” If it was, that person and their dependents were ineligible to sign up for insurance under the ACA.

But what if the employer’s plan was affordable for the employee, but it was unaffordable if they tried to cover their family? The government didn’t consider that. 

The new rule

The Biden administration has created a new rule that addresses the so-called family glitch. It now calculates whether your employer’s plan is affordable not just for you, but also for your dependents. 

If the coverage offered by your employer is not considered affordable for your dependents, they may now be newly eligible for ACA coverage.

Texas has many dependents who were in ‘family glitch’

An analysis published last year estimated that Texas had 671,000 dependents who fell into the family glitch, more than any other state. Even though some of them may now be eligible, it may still be too expensive depending on their household income. They have to survey the plans in the HealthCare Marketplace to find out.

Which plan is really the cheapest?

The Biden Administration has estimated that millions of Americans qualify for ACA coverage that costs less than $10 per month. But the plan with the lowest monthly premium may not be the cheapest plan for you. 

The plan categories go from the least expensive bronze to the most expensive platinum. If your income qualifies, you can get what they call cost-sharing reductions, which might make an upgraded silver plan cheaper than the lower level bronze plan. The Kaiser Family Foundation has a calculator tool to help you discern that. You can also check here.

What if you have already enrolled, but change your mind?

If you want to change the plan you have already selected, you can do that all the way through open enrollment. The sign up period goes through January 15, 2023. That gives you a lot of time to make up your mind and to change your mind and make a new selection. But make sure you are familiar with all the open enrollment deadlines.

Dec. 15 is the last day for you to enroll in or change a plan if you want your ACA insurance coverage to start on January 1, 2023 (assuming you have paid your first premium). 

If you sign up during the last part of open enrollment—anytime between Dec. 16, 2022 through Jan. 15, 2023, your health insurance plan won’t start covering you until Feb. 1, 2023 (again, assuming you have paid your first premium). 

That potentially missed month of coverage may be a big consideration for you if you have a condition that requires regular medical care. 

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