Archive for July, 2016

What You Need to Know About Plan Types

July 13, 2016

There are several types of plans to choose from in the health insurance marketplace. You might notice that many plans have 3-letter codes in their names: HMO, PPO, EPO, or POS.

Those letters tell you a little bit about what kind of provider options you have under that plan. A provider is a doctor, hospital, pharmacy, or other person or place you visit to get health care services. Here’s a little more about each type of plan:

  • Exclusive Provider Organization (EPO): EPO plans only cover services if you see doctors and other health care providers that are in-network, unless there’s an emergency. While you don’t need a referral to see a specialist, your plan might have fewer providers in-network for you to choose from.
  • Health Maintenance Organization (HMO): Often, an HMO plan only covers doctors and hospitals that are in-network, unless there’s an emergency. You may need a referral from your primary care provider to see a specialist. Many HMOs focus on preventive care and wellness.
  • Point of Service (POS): POS plans often require you to get a referral from your primary care doctor before seeing a specialist. Often, you pay less if you see doctors and other health care providers who are in-network.
  • Preferred Provider Organization (PPO): PPO plans often do not require you to get a referral from your primary care doctor before seeing a specialist. Often, you pay less if you see doctors and other health care providers who are in-network.

Before you pick a plan, it’s a good idea to make sure your doctors and hospitals are included in the plan’s provider network. You can check by calling your doctor or hospital and asking if they accept the plan.

Need a hand comparing health insurance plans? Check out the Plan Explorer.

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Immigrant Families Can Get Covered, Too!

June 23, 2016

If you moved to the United States from another country, welcome! Let’s talk about health insurance options for you and your family. Health insurance helps protect you (and your wallet) in case an unexpected illness or injury happens.

If you’re a U.S. citizen or you’re a lawfully present immigrant, you could sign up for a health insurance plan through the health insurance marketplace during open enrollment. That means you could qualify for financial help to lower your monthly costs — some folks could even qualify for free or low-cost coverage.

If people in your household have different immigration statuses, those who are lawfully present can enroll through the marketplace. Family members who do not apply for coverage in the marketplace will not be asked about their immigration status.

If you or someone in your family moves to the U.S. or their immigration status changes, they could qualify for a special enrollment period. That means they’ll have a 60-day window to enroll if they qualify.

There are a few facts you should know about marketplace plans:

  1. Financial help is available to those who qualify.
  2. You can get free, in-person help with your application. In many areas, you can get help in a language other than English.
  3. All plans offered in the marketplace must cover the important stuff: doctor visits, emergency care, maternity care, free preventive care, and much more.
  4. You cannot be turned down for health insurance based on a family member’s immigration status. And the information you provide to the marketplace cannot be used for immigration enforcement.

The marketplace opens for business starting November 1st, 2016 — mark your calendar, and get ready to get covered!

A Little Tip for New Dads

June 8, 2016

Parenthood comes with a lot of joy-filled moments, sleepless nights, and everything between. There’s also a lot of new stuff to figure out. This Father’s Day, we want to make sure that new and expecting dads know this: Having a baby or adopting a child gives you a special 60-day window to get covered through the marketplace.

Babies need a lot of care to make sure they get the shots they need and everything’s on track. Without health insurance, medical bills could add up fast. With health insurance, you can rest a little easier knowing that you and your baby are covered. Here’s what you need to know:

If you don’t already have health insurance, the whole family can get covered within 60 days of a birth or adoption. And you could qualify for financial help (sometimes your kids can get free or low-cost coverage even if you don’t qualify).

If you do have health insurance, you should update your marketplace account within 60 days of the birth or adoption. The amount of your financial help could change. You can add your baby to your current plan or shop for a new plan that better fits your new situation.

With health insurance, you’ll be one step closer to earning your “World’s Greatest Dad” coffee mug. And all you have to do is make an appointment to apply and get covered within 60 days of your bundle of joy’s arrival!

Make an appointment

What Every Graduating Senior Should Know About Health Coverage

May 24, 2016

Congrats Class of 2016 — you did it! Now what?

Before you turn your tassel to the left and walk down the stage, here’s one thing you should know: If you are under your school’s student health plan, you will likely lose your coverage soon.

But don’t worry! You have some options:

  1. Get covered through your parent’s health insurance plan. You can stay on your parent’s health plan until you’re 26.
  2. See if you could get health insurance through your employer. Ask your employer about the health benefits they offer and take advantage.
  3. Get your own plan through the marketplace. You’ll have 60 days from the date your student plan ends to get covered. Find the right plan that fits your budget and health needs. And remember: Financial help is available!
  4. See if you qualify for free or low-cost coverage through Medicaid. If you qualify, you can enroll at any time.

Here are a couple of post-grad life tips to help you get started:

Having health insurance gives you the peace of mind and protects your wallet. So before you go forth and conquer the world of adulting, make sure to get covered.

2016 Texas State of Enrollment Conference

May 18, 2016

Texas SOE 2016 Logo2


Thank you all for attending the 2016 State of Enrollment Conference! We hope you had a great time, learned a lot, and made many new and exciting connections.

As promised, the slides are available from last week’s plenary and workshop sessions. We look forward to working with you all in the field for the rest of the Special Enrollment Period, Open Enrollment 4, and beyond!

2016 Texas State of Enrollment Conference

Join Enroll America at the State of Enrollment Conference in San Antonio July 14-15.

With two days of plenaries, workshops, trainings, and networking events, the conference offered valuable opportunities to share ideas, learn from each other and plan for the future as we continue to help Texans enroll in and retain health coverage. Connecting with peers and partners from across the state as we took a critical look at what worked during the third open enrollment period for the health insurance marketplaces, what barriers remain to enrolling and retaining consumers in health coverage, and how we can continue working as a community to build and sustain momentum in our ongoing effort to get Texas covered for years to come.

Who: Enroll America and partners from all aspects of the outreach and enrollment effort

Where: Encino Ballroom, CentroMed, 3750 Commercial Ave, San Antonio, TX 78221

When: July 14-15, 2016

Conference Program



Program Overview

Enroll America convened our third state conference July 14-15, 2016, bringing together hundreds of attendees, including state and federal government officials, state-based and local partners, enrollment networks, and stakeholders in the health care sector. Attendees had the opportunity to hear and share lessons learned, new research, and best practices for ongoing outreach and enrollment efforts. With interactive and hands-on trainings, workshops, keynotes, and events, the conference offered valuable networking with Enroll America partners and staff from across the state and served as a premier opportunity to exchange learnings and build momentum for years to come. We hope to see you next year!

The agenda included sessions on:

  • Improving health insurance literacy
  • Helping consumers choose the right plan
  • Using data to support partner coordination
  • Digital/social media outreach
  • Working with city and county health departments
  • Consumer advocacy
  • Messaging and communications strategy
  • Overview of enrollment tools


Who Attends the State of Enrollment Conference?

The conference brings together attendees from all aspects of the outreach and enrollment effort, including navigators and assisters, state and federal government officials, state-based and local partners, hospital systems, health plans, enrollment networks, along with other stakeholders leading and implementing enrollment in Medicaid and the Health Insurance Marketplaces.

Conference Attendees



Conference Sponsors

Enroll America Texas would like to thank the following sponsors for making the 2016 Texas State of Employment possible!

Gold Sponsor:

CFHP Logo_stacked_tag_color

Silver Sponsors:




Scholarship Sponsor:

Ambetter%20from%20Superior%20HealthPlan%20Main Logo

5 Quick Facts About Health Insurance and Your Taxes

April 5, 2016

It’s tax time! While it may not be your favorite time of year, there are a few things you should know about how health insurance could impact your taxes.

  1. You must tell the IRS whether you had health insurance for the whole year.
  2. If you got financial help to pay for health insurance, you’ll get a form in the mail with info about your financial help. It’s called a Form 1095-A. You should enter this info on your taxes much like you would a W-2.
  3. If your income or family size changed during 2015, that could change the amount of financial help you qualify for. It’s possible that you’ll get a larger refund or owe some money back if either of these situations happened to you.
  4. If you had Medicaid or health insurance through work, you’ll simply check a box saying that you had coverage for 2015.
  5. If you did not have health insurance, you might face a fine of $325 per adult or 2% of your income. If you didn’t have coverage for part of 2015, the fine will be adjusted based on how long you were uninsured. (Some people may not have to pay the fine — learn more about exemptions here.)

If you don’t have health insurance, you should know that the fine increases for 2016. It’s $695 per person or 2.5% of your income — whichever is more. Yikes! Why not see if you could get covered?

Learn more

New Data: More than 1.3 Million Texans Got Covered During Affordable Care Act’s Third Open Enrollment Period

February 4, 2016

New HHS data shows Texans eager to enroll in quality, affordable coverage through the Affordable Care Act.

AUSTIN, TEXAS – Today, the U.S. Department of Health and Human Services (HHS) announced that more than 1.3 million Texans enrolled in health coverage through the Affordable Care Act during the third open enrollment period of the Affordable Care Act, which ended on January 31, 2016.

“Today’s announcement from HHS shows what we’ve been seeing in communities across Texas – consumers are hungry for affordable health coverage and jumped at the opportunity to protect themselves and their family,” said Mimi Garcia, Texas State Director for Enroll America. “And of the 1,306,208 Texans that enrolled or reenrolled in coverage, we know the vast majority of them received financial help to lower the monthly premiums and make their plan truly affordable. Despite these encouraging statistics, we know that there is more work to be done across the Lone Star State to continue educating Texans about their coverage options.”

During the third open enrollment period, Enroll America and its partners in Texas worked together in the final weeks to help Texans get covered. Eight out of 10 of the fastest growing markets between Week 12 and Week 13 are in Texas: Corpus Christ (17 percent); Harlingen (16 percent); Laredo (16 percent); El Paso (14 percent); Odessa-Midland (14 percent); San Antonio (14 percent); Abilene-Sweetwater (13 percent); and Lubbock (12 percent).

In fact, during the third open enrollment period alone, Enroll America and its partners offered consumers nearly 600,000 free appointments through the digital Get Covered Connector to meet with enrollment assisters across Texas that could sit down with them, answer their questions, and help them through the enrollment process.

With the open enrollment period now closed, Enroll America and its partners will continue to educate Texans on their health care options and also help those who qualify for special enrollment periods get the coverage they need.

Uninsured Texans who did not take action before the January 31 enrollment deadline will likely face a fine of at least $695, on top of having to pay out-of-pocket for treatment during 2016.

Though the marketplace enrollment period has ended, uninsured Texans who experience a qualifying life event such as having a child, losing job-based coverage, or getting married may be able to enroll in coverage before the next open enrollment period begins. Enrollment in Medicaid is also year round, so qualifying Texans can enroll in Medicaid today.

If any Texan has questions about their coverage or wants to learn more about their current enrollment options, they can schedule a free appointment with an enrollment expert in their community by using the Get Covered Connector.

Steven’s Health Care Story: “I Still Intend on Living A Whole Lot More”

January 21, 2016

This post originally appeared on

Today is National Youth Enrollment Day, a collaborative effort to educate young adults cross the country on the importance of having health insurance. Find out how you can get covered at

It was a cold February day like any other in Washington D.C., and my recreational soccer team was meeting up after work to prepare for our game. As we played that night in the snow, I began to notice some pain in my lower back. I shrugged it off. I was playing hard, I wanted to win, and I figured I had probably just hurt myself in the gym.

After ignoring the pain for several weeks, I finally convinced myself to go see a doctor at my local urgent care. The doctor there checked me out and noticed that I had developed some swelling in one of my testicles. She referred me to a specialist right away, and in one week I saw a urologist, had an ultrasound done, an MRI, a CT scan, blood work, and eventually an oncologist only to learn that I had stage III testicular cancer with a 7.5 cm tumor growing in my abdomen.

I remember being shocked when I heard the “C-word” for the very first time, as I imagine anyone would be. How could this have happened? I’m an active, healthy 25-year-old guy. I felt as though my whole world was spinning out from under me. It turns out that testicular cancer is just bad luck, an unfortunate mutation of my DNA. But let me tell you, that doesn’t make the diagnosis any easier to bear.

Fortunately for me, testicular cancer, even at stage III, is curable. But not without a fight. After two major operations, three months of chemotherapy, and more doctor visits than I can count, I was given the news I was always hoping for, but never promised. I was declared cancer-free in October, and this horrible burden was lifted from my shoulders.

The holiday season just came and went, and I have a lot to be grateful for. Most importantly my health, but I have a lot to be thankful for in terms of what went right for me. I am grateful that I never hesitated to go to the doctor when I first suspected something was wrong. I was able to do that because I had health insurance. In fact, I was still on my parent’s plan. I am grateful that as I turned 26, halfway through chemotherapy mind you (that was a fun birthday), I was able to enroll in a plan of my own, no questions asked. I’m even more grateful that I don’t have to worry about having a pre-existing condition follow me around the rest of my life, because although I was diagnosed with cancer at the age of 25, I still intend on living a whole lot more.

This was a journey I never intended to take, but was one that showed me the value of having health insurance and the importance of seeing a doctor. When I was first diagnosed, I remember my doctor saying, “You know Steven, men usually have a pretty good idea when something is wrong with their bodies, particularly their sexual health. Getting them to go see a doctor however, is a whole other story. If more young men came in to see the doctor, we could prevent a lot of tragedies.” I couldn’t agree more.

Steven Avila currently lives in Washington D.C. and is a political appointee at the Department of the Interior.

Health Insurance: The Good, the Bad, and the Fine

January 15, 2016

The good: You can sign up right now for quality, affordable health insurance. Most people will qualify for financial help, and get this: For those that do, the average amount of financial help when they sign up is $294 a month!

The bad: You only have until January 31st to sign up for a plan.

The fine: If you don’t have coverage in 2016, you could face a fine of $695 per adult ($347.50 per child) or 2.5% of your income — whichever is more. Yikes!

Why don’t we take a look at the math to see what that actually means?

Let’s say a family has 2 married adults and 2 children, and has an income of $55,000 a year. No one in the family has insurance.

$695 x 2 adults = $1,390

$347.50 x 2 children = $695

$1,390 + $695 = $2,085

This family would pay a fine of $2,085 for not having health insurance.

Okay, now let’s say a household contains 2 uninsured married adults and has an income of $80,000 per year.

Household income: $80,000

Tax filing threshold: $20,600

$80,000 – $20,600 = $59,400 of income is subject to the fine

2.5% of $54,400 = $1,485 ($695 x 2 adults = $1,390, which is less than 2.5% of their income)

This family would pay a fine of $1,485 for not having health insurance.

The fine is taken out of your tax refund. In some unique cases, you may not have to pay the fine.

But with financial help available, you might as well take a look at your options! Ready to get started?

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Quedan cinco días para la fecha límite: ¡Inscríbete en o antes del 15 de diciembre para tener cobertura desde el comienzo del nuevo año!

December 10, 2015

El 15 de diciembre es el último día para inscribirte si quieres que tu plan médico empiece a cubrirte el 1º de enero
AUSTIN– Ya mismo llega el 15 de diciembre, fecha en que los residentes de Texas sin un seguro médico que deseen cobertura de salud económica y de calidad a través del Mercado de Seguros Médicos deberán inscribirse para que su nueva cobertura empiece a cubrirles el 1º de enero del 2016. En el caso de los consumidores que necesitan renovar su plan médico, el 15 de diciembre también es su último día para escoger un plan médico que empiece a cubrirles a partir del 1º de enero, evitando así un lapso en su cobertura de salud.

Enroll America exhorta a todos los residentes de Texas que no tienen un seguro de salud a aprovechar los planes médicos de calidad y la ayuda financiera que Obacamare ha hecho posibles. Las personas que no se inscriban en un seguro médico tal vez tengan que pagar una multa en el 2016.

Aquí cinco cosas que todos los residentes de Texas necesitan saber sobre cómo obtener cobertura en o antes del 15 de diciembre:

1. El 15 de diciembre es la primera fecha límite del periodo de inscripción abierta.

El periodo de inscripción abierta del Mercado de Seguros Médicos de Obamacare dura tres meses, del 1º de noviembre de 2015 al 31 de enero de 2016. Durante ese tiempo, los residentes de Texas pueden ir al Mercado y seleccionar un plan que cumpla con sus necesidades y presupuesto. Los residentes de Texas que actualmente tienen cobertura de salud a través del Mercado de Seguros Médicos, o que tienen un plan individual obtenido fuera del Mercado, también podrán ver los nuevos planes médicos disponibles y elegir el mejor para ellos. Inscribirse en o antes del 15 de diciembre garantiza la cobertura médica a partir del Día de Año Nuevo, y eso te da la paz mental de saber que tú y tu familia están protegidos.

2. ¡85 % de los residentes de Texas obtuvieron ayuda financiera para hacer su seguro médico más económico!

Para muchos residentes de Texas, los gastos del cuidado médico son una preocupación muy real al tomar decisiones de salud. En el pasado las primas de los seguros médicos eran tan caras, que muchas personas no podían pagarlas.

Pero ahora se ofrece ayuda financiera para ayudarte a pagar tu plan médico. De hecho, para junio del 2015, más de 940,000 residentes de Texas se habían inscrito en cobertura de salud a través del Mercado y, de esos residentes, el 85 % recibió ayuda financiera para hacer sus pagos mensuales realmente económicos. Averigua cuánta ayuda financiera puedes recibir con Obamacare usando la calculadora Get Covered, disponible en

3. Hay ayuda gratuita y en persona disponible para que entiendas tus opciones y te inscribas en un plan.

Para muchas personas el proceso de inscripción puede ser confuso, especialmente si llevan mucho tiempo sin seguro médico. Pero lo bueno es que puedes recibir ayuda gratuita y en persona en tu comunidad, de expertos certificados que se sentarán contigo y te explicarán imparcialmente tus opciones para que puedas tomar la mejor decisión de cobertura de salud para ti y tu familia. Si ya tienes seguro a través de Obamacare, estos expertos te pueden ayudar a renovar tu plan médico si deseas conservarlo, o ayudarte a seleccionar un plan nuevo. Puedes encontrar ayuda cerca de ti y hacer una cita usando la herramienta Get Covered Connector, disponible en

4. Los planes médicos y los precios cambian cada año, y ahora puedes comparar planes fácilmente.

Las personas tienen necesidades y situaciones financieras distintas, y la gran variedad de planes médicos puede ser abrumadora. Por esa razón, Get Covered America ahora ofrece una herramienta de comparación de planes médicos (en inglés), llamada Get Covered Plan Explorer, para brindarte información actualizada y fácil de entender sobre tus opciones de cobertura médica.

Con tan solo contestar varias preguntas sencillas sobre tu hogar, la herramienta Plan Explorer generará una lista de planes disponibles que cumplen con tus necesidades, incluyendo si puedes atenderte con tus médicos actuales. La herramienta también usa la prima mensual y los gastos de bolsillo estimados de cada plan para darte una buena idea de lo que deberás pagar a lo largo del año. Y como la herramienta te permite comparar planes lado a lado, podrás sentirte confiado de que el plan que escoges es el mejor para tus necesidades y presupuesto anual. Explora tus opciones con alguien que sea bilingüe usando

5. Si no te inscribes en seguro médico, quizás tengas que pagar una multa al pagar impuestos.

El periodo de inscripción abierta no solo te da la oportunidad de obtener seguro de salud económico y de calidad para ti y tu familia, sino también te ayudará a evitar tener que pagar una multa al presentar tu declaración de impuestos. Si no te inscribes en un plan médico para la fecha final del 31 de enero de 2016, quizás tengas que pagar una multa de $695 o 2.5 % de tus ingresos anuales, la cantidad que sea mayor. La multa aumentará cada año, así que cada año será más caro no cumplir con la ley, y para colmo tendrás que pagar de tu bolsillo todos los servicios de salud que requieras, lo cual puede ser costoso. Inscribirte en cobertura de salud no solo podría ahorrarte y ahorrarle a tu familia $695 o más, sino que también te brinda cuidado preventivo, cobertura de medicamentos recetados y otros elementos esenciales para una vida saludable.

Ve a para aprender más sobre Obamacare, tus opciones de cobertura de salud y cómo ayudar a tus familiares y amigos a obtener cobertura.

Síguenos en Twitter: @GetCoveredTX

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