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How Do You Get Health Insurance in Texas?

You have many options for health insurance in Texas. What’s best for you depends on factors such as age, income, family size and health conditions. The federal marketplace is a good starting point to find health coverage.

You can compare plans online, get help over the phone or locate an in-person navigator. Additionally, if you’re looking online, you can turn to private, nongovernmental websites to help you find and compare your options.

Here are some facts you may or may not know about health insurance in Texas:

  • Under President Biden’s American Rescue Plan, you have through August 15, 2021, to sign up for health insurance through the Affordable Care Act, or Obamacare.
  • The American Rescue Plan expanded subsidies, making more people eligible and increasing the amounts you can receive to pay monthly premiums.
  • Other options for insurance include free or low-cost coverage through Medicaid or Medicare and short-term health insurance.

What are your Texas health insurance options?

There are several different kinds of options for health insurance.

  • Affordable Care Act (ACA): Under the ACA, you can buy health insurance through a state or federal Marketplace. Nearly 1.3 million Texans enrolled in an ACA health plan in 2020.
  • Private Individual Health Insurance: Outside of the ACA Marketplace, health insurance companies offer private plans anyone can purchase.
  • Medicare: Medicare is a federal health insurance program for anyone age 65 or older or with a disability. Texas ranks third in the US for the number of Medicare enrollees.
  • Medicaid and CHIP: Medicaid and the Children’s Health Insurance Program (CHIP) provide publicly-funded health insurance for some low-income residents.
  • Short-Term Health Insurance: Short-term plans offer gap coverage and may be an option if you’re between jobs or waiting for new coverage to begin.

 

What is the Affordable Care Act in Texas?

The Affordable Care Act was made to increase health insurance access by lowering the cost for those who qualify. Under the ACA, plans must cover a core set of essential health benefits such as preventive, mental health, and maternity care.

Plans in the marketplace are divided into four levels — bronze, silver, gold, and platinum. These levels vary by how much you and your insurance company pay for covered healthcare services.

If you enroll in a bronze plan, you pay lower monthly premiums but more out of pocket for services (40% after you reach your deductible). With a platinum plan, you pay higher premiums but less when you actually see the doctor or get an exam (10% after you reach your deductible).

Subsidies are a key feature of the Affordable Care Act. Most people who enroll in an ACA plan get help paying their monthly premium.

You can sign up for a plan during the Open Enrollment Period, which takes place from November 1 to December 15. You could also enroll during a Special Enrollment Period if you experience a big change in your life such as the birth of a child or marriage.

This year, the federal government opened a Special Enrollment Period through August 15 due to COVID-19, and they also expanded subsidies. If you need health coverage, now is a great time to sign up for an ACA plan.

What are private health insurance options in Texas?

Health insurance companies allow you to purchase individual and family plans directly from them. You may also turn to private online marketplaces that allow you to compare costs, plans and benefits from different carriers.

Note: If you purchase a plan outside the ACA Marketplace, you won’t qualify for a subsidy.

What is Medicare in Texas?

If you’re 65 and up or have a disability, you may qualify for Medicare. You generally choose from two options — Medicare or Original Medicare and Medicare Advantage.

Original Medicare covers hospital care (Part A) and doctor’s visits and other outpatient services (Part B). You can also buy prescription drug coverage (Part D).

Medicare Advantage plans (also called Part C) combine features of Original Medicare with other benefits into one policy. Run by private insurance companies, Medicare Advantage plans often offer drug coverage and extra benefits for services Medicare doesn’t cover, like eye exams, dental care, and hearing aids.

What is Medicaid and CHIP in Texas?

Children and adults who are low income may qualify for health insurance coverage through Texas Medicaid.

Eligibility requirements include:

  • A child younger than 19
  • An Adult caring for a related child under age 17 or 18 if attending school full time and living in the same household
  • A pregnant woman
  • Adults 64 and older who need 30 or more days of long-term care.
  • Former foster care child up to age 26.

 

Texas’ Child Health Insurance Program (CHIP) also provides coverage for children 19 and under whose families earn too much to qualify for Medicaid.

What is short-term health insurance in Texas? 

Short-term health insurance in Texas provides coverage when you have gaps in your insurance. Examples include when you’re between jobs or waiting for new coverage to start.

In Texas, short-term health insurance plans are limited to 364 days, with renewals up to 36 months. Short-term plans are a low-cost option. But they generally don’t cover preexisting conditions and aren’t required to cover the ACA essential health benefits.

How much does health insurance cost in Texas?

  • Affordable Care Act: The average monthly premium for a silver plan in Texas is a little over $400. When shopping for ACA plans, don’t forget to compare the deductibles, copayments and coinsurance.
  • Medicare: For Medicare Part A, you’ll pay an annual deductible and copay but no monthly premium if you paid Medicare taxes for 10 years or more. For Part B, you pay a  monthly premium of about $150 (or higher, depending on your income) plus an additional deductible and 20% coinsurance. Part D premiums vary by plan.
  • Medicare Advantage: The average monthly premium for a Medicare Advantage plan in Texas is a little over $10. In addition, you’ll pay the Part B premium that is required to enroll in a Medicare Advantage plan.
  • Medicaid: If you qualify for Medicaid, there’s usually no cost for covered services. For CHIP, there are enrollment fees and copays based on your family’s income. Annual enrollment fees run $50 or less, while copays range from $3 to $35 per service.
  • Short-Term Health Insurance: Short-term health insurance plans generally cost less than ACA plans, but your out-of-pocket expenses may be higher.

 

How do you sign up for health insurance in Texas?

To sign up for an ACA plan, you can visit HealthCare.gov. You can also get help over the phone or in person. Private, commercial websites are also available to compare health plans and enroll.

To check your eligibility and sign up for Original Medicare and Medicare Advantage plans, visit Medicare.gov. To apply for Medicaid or CHIP, visit Your Texas Benefits.

For short-term health insurance, you’ll need to check with health insurance companies that offer these types of plans.

When shopping for health insurance, make sure to compare the costs and coverage of all plans available to you. By taking time to understand your options, you’ll find a plan that meets your family’s health needs and budget.

This content is brought to you by Anne Davis.

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