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Open enrollment strategies to get the best healthcare plan

More than 400,000 Texans are without health insurance because of the coronavirus. They may be eligible to find coverage under the ACA or Medicare.

SAN ANTONIO — Health insurance options can be complicated, especially when it comes to figuring out what is covered.

“Research is critical,” said Jason Resendez, with Consumers for Quality Care. “We've got to think about this like you go to Best Buy and think about what TV you want, what features you want. You've got to take that same mindset when it comes to a health care plan.”

There's three items to keep in mind if you are shopping the healthcare marketplace as part of the Affordable Care Act (ACA). First, know your network to avoid any surprise bills.

“This often happens when you don’t know your network. So, when you’re selecting a plan, understand the breadth of the network that you’re getting yourselves into,” Resendez said. 

Next, be aware of what short-term limited duration insurance plans cover and do not cover.

“They don’t cover preexisting conditions,” Resendez said. “They don’t cover preventative services. They look good on paper because the premiums are low, but when rubber meets the road you get saddled with a big bill.”

Plus, understand copay adjustment programs.

“Which limit your ability to apply a manufacturer or drug coupon to meet your deductible,” Resendez added. “It limits your options for covering out-of-pocket costs at the pharmacy counter with drug coupons.”

You have until Dec. 15 to sign up for a plan on the ACA marketplace.

Check and see if you meet the income requirements to sign up for Medicaid.

“So you’ve lost income or lost your job, make sure to find out if you qualify for Medicaid,” Resendez suggests. 

If you qualify for Medicare, the Federal Trade Commission said there are rules for sellers:

  • They cannot say you need to sign up before the December 7 deadline. You will not get any extra benefits for signing up early.
  • They cannot call you if you do not already have an established relationship with their company.
  • They cannot call, email or visit your home unless you agree to those forms of contact.
  • They cannot discuss other insurance products like life insurance.
  • They cannot say Medicare endorses or prefers their plan. They also cannot offer you gifts to sign up or threaten to take away benefits if you do not sign up.

Get the details in writing before you sign up. Read your plan and verify the particulars by checking if your doctor is in network. And, no matter where you look for health insurance:

“Don’t be afraid to ask questions,” Resendez said. “Call the insurer. Call the marketplace and ask your questions. Know that you don’t have to decide all this in one day, one hour.”

Again, the deadline to sign up for Medicare is Dec. 7. The deadline to sign up for a plan under the ACA marketplace is Dec. 15.

Protect both your health and wallet by enrolling in the right plan.

Also, hang up if someone calls asking for your Medicare number. It could be a schemer trying to file a false claim. A legitimate Medicare employee will always have you number on file.