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123 plans await Dallas shoppers when HealthCare.gov opens enrollment Tuesday

Eight insurers are offering options for next year, including two returning carriers: Cigna and Aetna CVS Health

Two insurance companies serving Dallas-Fort Worth — Bright Health and Friday Health Plans — are pulling their plans off HealthCare.gov for 2023. But two others are returning to the local market, and they’re big brand names: Cigna Healthcare and Aetna CVS Health.

While churn is not unusual on the exchange, recent trends have been all about expansion.

From 2017-19, when Republicans controlled the White House and threatened to repeal the Affordable Care Act, the Dallas area had just three insurers on the exchange. For 2023, the region will have eight insurers offering 123 plans in the bronze, silver and gold tiers.

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Many plans have zero deductibles and co-pays, and some are tailored for people with particular conditions, such as diabetes. In addition, the vast majority of customers using HealthCare.gov qualify for subsidies that cover a large portion of the monthly premium — or all of it.

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That means hundreds of thousands of North Texas residents will have lots to choose from when open enrollment begins Tuesday and continues until Jan. 15.

“Marketplace premiums should go down for most consumers,” said Jennifer Chumbley Hogue, an insurance broker in the Dallas area and an analyst for healthinsurance.org.

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Hogue cited higher subsidies approved by Congress and an increase in the eligibility cap for some households earning over 400% of the federal poverty level.

There’s also been a recent rule change to fix the so-called family glitch. That occurs when a breadwinner gets coverage from work but cannot afford to add a spouse and kids, and those family members are ineligible for subsidies.

Lawmakers in Austin passed a rate-stabilization bill, Hogue said, and that should lead to better deals, too.

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“Bronze and gold plan premiums should decrease,” she said, referring to the most economical and most costly options. “Silver plan premiums should increase, which will increase the amount of subsidy per person.”

Four out of five customers on HealthCare.gov will be able to find a plan for $10 a month or less after subsidies, the Centers for Medicare & Medicaid Services said Wednesday.

This year, 94% of Texans signing up on HealthCare.gov received subsidies for premiums. For those getting a subsidy, the average premium was $60 a month, and nearly 4 in 10 Texas customers paid $10 or less after tax credits.

Actual prices on the exchange vary widely, depending on family income, the number of people insured and the coverage selected. Some consumers want lower monthly premiums while others are more concerned about deductibles and out-of-pocket costs.

“There is no one size fits all,” Hogue said.

Cigna offered HealthCare.gov plans in Dallas when the exchange launched in 2014, but it exited Texas three years later. Now it’s back for 2023 with an approach focused on affordability and tapping the provider networks serving its commercial insurance.

“We needed to step back and, quite frankly, take a reset,” said Lisa Lough, president of Cigna’s individual and family plans business. “We needed to get a little bit smarter and come back with stronger products and stronger networks that are really going to deliver value and affordability.”

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Cigna’s return will start in three Texas markets: around Dallas-Fort Worth, Lubbock and El Paso. Lough referred to that as “step one.”

“We have a goal of continuing to build that out,” Lough said. “We’re in Texas for the long haul.”

Cigna has plans tailored for diabetics, including capping insulin charges at $25 a month and offering free testing strips and other discounted items.

“It may be a way to pull in people” who are not insured and not managing their conditions, Lough said.

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Aetna also offered HealthCare.gov plans in Dallas from 2014 to 2016 before leaving the region and state. The insurer, acquired by CVS Health in 2018, said it was drawn back because the exchange market has stabilized — politically, financially and on the regulatory front.

It’s also become more crucial for individuals and families who don’t get insurance through a job.

“Whether it’s the great resignation, the growing gig economy or [the threat of] COVID, more people are looking for individual coverage than ever before,” said Anand Shukla, senior vice president of Aetna’s individual market.

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The number of customers has expanded rapidly. Nationwide, 14.5 million signed up for an ACA plan in 2022, up from 11.4 million two years earlier.

In Texas, over 1.84 million enrolled for 2022, a one-year gain of 42% — the biggest in the country and twice the average gain for all states.

Aetna is focusing on accessibility and affordability, emphasizing services available at walk-in clinics inside CVS — often with zero co-pays. Customers can avoid an unnecessary trip to the emergency room or a long wait for a doctor’s appointment, Shukla said.

“Many of our members work multiple jobs,” he said, and they stand to lose pay if they take off during business hours.

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Baylor Scott & White, which returned to the ACA market serving D-FW in 2021, also said affordability was crucial to succeeding on the exchange.

“People who qualify for these subsidies don’t have a lot of money to spend out of pocket,” said Jeff Ingrum, CEO of the Baylor Scott & White Health Plan.

The best way to deliver affordable, high-quality care, Ingrum believes, is to use Baylor’s network of providers. Those same providers are offered on all nine exchange plans, from the least expensive bronze to the most expensive gold tier.

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That allows customers to compare Baylor’s offers on financial terms — premiums, deductibles, out-of-pocket maximums: “We’ve tried to keep it simple,” he said.

The approach has worked well in retaining customers, he added, and that stability allows insurers to rate their risks more accurately.

The biggest turnover has been among low-income customers, who tend to be most price-sensitive. The two insurers leaving Texas — the Bright and Friday health plans — had entered the market with low entry prices and grabbed market share.

But Bright lost $432 million in the first six months of this year, and announced this month it was leaving the exchange in multiple states. A few days later, Friday said it would exit, too — after proposing a 30% increase in premiums.

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The departures will force thousands of customers to change plans during open enrollment — or be re-enrolled automatically into similar-priced offers. Hogue, the insurance analyst, suggests that consumers take the reins and compare choices on HealthCare.gov, perhaps with the help of a navigator or broker.

If they value a particular provider, that’s a good place to start the process.

“When a doctor or hospital is critical to your happiness, call the doctor’s office and say, ‘Which marketplace plans are you going to accept in 2023?’” Hogue said. “They know the answer because they’re the ones looking at the patients’ ID cards.”

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