About 1.4 million Texans have lost Medicaid coverage so far this year as the state continues to check eligibility. Since federal pandemic-era protections ended in early 2023, more than 11.7 million people nationally have lost Medicaid coverage, according to data from the Kaiser Family Foundation.
That’s made periods like open enrollment, taking place through January 15, even more important for Texans and the navigators who help them find health plans through the ACA Marketplace.
Daniel Bouton is the senior director of family and community health at the United Way of Metropolitan Dallas, overseeing teams that help underinsured and uninsured clients find health care.
“It is a different year because there’s so many people that almost are facing a surprise factor of losing Medicaid,” he said. “In the past three years, many people changed jobs, and started making a little bit more money that put them over the threshold for Medicaid.”
He said his team has helped people who are self-employed and young adults who have aged out of Medicaid find coverage. Bouton said clients are often wondering how they can afford insurance plans and how to stay in-network for doctors they already see.
“There are options to apply for financial assistance through [Marketplace] to help with the cost of those premiums,” he said.
Enrollment takes place this year between November 1 and January 15. To be covered starting in January for 2024, people need to submit their applications by Dec. 15.
According to data from the U.S. Centers for Medicare and Medicaid Services, about 4.5 million people so far have signed up for Marketplace plans form 2024 across the country. This includes close to 98,000 Texans.
AccelHealth Benefits Coordinator Christina Martinez in Stephenville said she often meets with clients who feel nervous because they haven’t had insurance before or aren’t sure what to expect during the enrollment process.
“Even for us navigators, there’ll be something on there that we’ll have to take a look at a little bit harder,” she said. “It is very difficult sometimes for somebody who has never used a computer, or they don’t know anything about insurance.”
Martinez said she takes it “step-by-step” with clients and answers every question they have.
“We don’t let them leave without knowing exactly how things work,” she said.
Marketplace plans cover pre-existing conditions, like diabetes, along with routine check-ups and other health services like emergency room visits and prescriptions.
To renew or apply for a plan, people will need to have tax forms, W-2s and income paperwork, and other identifying documents like Social Security numbers.
Martinez has helped families sign up for Marketplace plans after they were denied Medicaid coverage this year.
“A lot of people are uninsured,” she said. “We live in a society where it’s not fair sometimes that you age out of Medicaid, or you don’t make enough for Marketplace, so every year that this happens we try to look at what can we do better. Our goal is just to continue to help the uninsured.”
Ismael Cruz, the health benefits director for Prism Health North Texas, said it’s crucial clients “understand the importance for us to have a medical plan.”
“[You] never know when you can have an emergency, and you have to be prepared for those situations.”
People can search an online directory on HealthCare.gov to find a navigator nearby or call 800-318-2596 to talk to someone about options.
Prism Health North Texas is also hosting an open enrollment event on Saturday, Dec. 9, from 8:30 a.m. to 12:00 p.m. at the health center on 4004 Worth St. in Dallas.
Got a tip? Email Elena Rivera at erivera@kera.org
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