The Texas Health Insurance Exchange
The health insurance exchange serving the state of Texas is run by the federal government, specifically the Department of Health and Human Services. The exchange, also called the marketplace, is a development of the Affordable Care Act designed to insure more Americans by offering government-subsidized coverage. As the government provides tax credits to those with a low to moderate income, insurance is easier to afford and care is easier to obtain. Each of the health plans offered on the exchange features a set of at least ten “essential health benefits”, which are commonly used services a policy must cover.
So that more people are aware of the exchanges that operate in every state, the health care law enforces that coverage is mandatory for anyone who can afford it. For many Texans, the marketplace will be the only source of coverage that’s affordable when paired with financial assistance. While standard individual health plans will also help you evade the penalty for being uninsured, tax credits are only offered to customers of the exchange.
You can apply for Texas exchange coverage online, through a licensed Texas health insurance agent, or at a local hospital or health care facility where exchange workers are able to help you enroll. These workers, called certified application counselors and navigators, are not insurance agents, but they can explain the process of applying for coverage, how your plan will work, and how to apply for financial assistance.
For a more thorough explanation from an agent certified to sell marketplace coverage, call us at 888 803 5917. Our agents have completed training to sell plans on and off the exchange in virtually every state, and certainly in Texas, where we have many years of experience with standard individual and family coverage. And aside from our site, you can look for exchange plans in Texas on Healthcare.gov, the HHS website where marketplace coverage is available.
How the Marketplace Was Formed
Despite much resistance from Texas officials, the state set up an exchange so that more individuals, families and small businesses could purchase coverage at a reduced rate. Once the ACA became law in 2010, the Texas Department of Insurance teamed up with the Health and Human Services Commission to investigate how to make this program work. $1 million in grant money from the federal government was given to Texas to plan the exchange, but the state returned all but $100,000 after refusing to further organize a marketplace. In July 2012, Governor Rick Perry informed the HHS that Texas would not run its own exchange, allowing the federal government to manage all aspects of the new insurance plans.
What is the Texas Marketplace?
The health insurance marketplace is a resource for uninsured people in Texas who can’t get coverage through their job or the state’s Medicaid program. On the exchange, you can buy coverage that’s almost identical to standard, non-marketplace individual health plans. Many of the same carriers sell plans to individuals on and off the exchange.
The key difference is that only exchange plans can receive financial assistance through subsidies. Tax credits are issued by the Internal Revenue Service (IRS), and help make premiums more affordable to those who earn between 100 and 400% FPL, and assist with cost sharing for Texans with income between 100 and 250% FPL.
Subsidies for Individuals and Families
Premium Assistance: 100-400% FPL
Lowers your monthly bill for insurance coverage based on a percentage of taxable income.
Cost-Sharing Assistance: 100-250% FPL
Reduces copays, coinsurance and deductibles for low-income policyholders to keep care affordable.
Four tiers of cost-sharing are available for every qualified health plan on the exchange. The same types of plans are also sold by plans off the exchange, as well. Qualified health plans comply with the ACA, making sure that people purchase adequate coverage, which according to the law is at least 60/40 — a “bronze” plan. Plans are streamlined to make shopping for insurance easier, with four metallic coverage levels to choose from and catastrophic plans for younger residents. You can choose from a variety of deductibles to fit your needs and adjust your premium, as well.
Bronze: Plan covers 60% after deductible, you pay 40% coinsurance. Lowest premiums in exchange for higher cost sharing.
Silver: Plan covers 70% after deductible, you pay 30% coinsurance. Modest premiums and cost sharing.
Gold: Plan covers 80% after deductible, you pay 20% coinsurance. Lower cost sharing for a moderately high premium.
Platinum: Plan covers 90% after deductible, you pay 10% coinsurance. Higher premiums for the smallest share of medical costs.
Catastrophic: Lowest premiums for 100% coverage of preventive services and four office visits per year. Only available to healthy Texans under age 30.
Premium Rates for Texas Exchange
The table below illustrates the average premiums for various Texans, including a 27-year-old, 50-year-old, a family of four with 30-year-old parents, a 30-year-old parent with two children, a 40-year-old couple, and a child under age 21. The averages are a general outline, and plan costs can vary by zip code, family size, age, tobacco use, and company. As catastrophic plans are not available to individuals over 30, examples with older plan members are listed as N/A for that plan type.
Compare Texas Marketplace Plans
Below is a cost comparison tool providing a closer look at the marketplace policies in Texas. These rates are calculated by average premiums released by Texas insurers on the exchange. If you’re interested in one of the plans you find in your results, or for a more precise quote, call an agent at 888 803 5917.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.