How the Texas Health Benefits Exchange Marketplace Works

The Texas health insurance exchange will be federally run by HHS after Rick Parry decided not to run a state based health insurance exchange in Texas. Texas has the highest percentage of uninsured in the country. 25% of Texans are currently uninsured, although the State will not run it’s own exchange the federal Government will step in to run the exchanges to help insure Texans. If Texas implements all the provisions of ObamaCare 3 million Texans are projected to be insured through the exchanges.

• Coverage purchased before the 15th starts on the first of the month following the next month.

• You can obtain coverage, apply for cost assistance, or switch plans at anytime during open enrollment.  Open Enrollment 2015 starts November 15th, 2014 and ends February 15th, 2015.

• Open enrollment is the only time you can use the marketplace without qualifying for a special enrollment period.

• Not everyone who doesn’t have insurance will be charged a fee or will get cost assistance. How much you pay depends on what you make.

• All health insurance sold on official ObamaCare websites must include all the new benefits, rights and protections of the Affordable Care Act.

• HealthCare.gov is your State’s official ObamaCare website for Texas.

Texas Health Insurance Plans

Texas Exchange Subsides and Tax Credits

Although Texas has declined a State run health insurance exchange Texans will still be able to shop for subsidized insurance online. ObamaCare subsidizes those with incomes ranging from 139% to 400% of the FLP (federal poverty level) and helps to make Medicaid and CHIP available for those below the 139% mark. in 2013 400% FPL is $45,960 for single person, $62,040 for a family of two, and $78,120 for a family of three. Subsidies are given as refundable tax credits.

Applying for Subsidies, Tax Credits and Cost Assistance on the Texas Health Insurance Exchange

Just like any other State regardless of what type of exchange they run in order to get subsidies those between 133% and 400% of the FLP will need to sign up for the Texas health benefits / health insurance exchange. Inputting your families information and your tax information into the system will automatically calculate your subsidies.

Applying for ObamaCare in Texas

Make sure you have the following information about your and your family before visiting HealthCare.gov, your State’s official Health Insurance Marketplace.

• Last years tax information for you and your family.

• Projected incomes for this year.

• Medical history – ObamaCare does away with pre-existing conditions and gender discrimination so these factors will no longer affect the cost of your insurance. Smoking, family size and age may still affect your affect cost.

• Social Security Numbers (or document numbers for legal immigrants).

• Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2 forms—Wage and Tax Statements).

• Policy numbers for any current health insurance plans covering members of your household.

• A completed Employer Coverage Tool for every job-based plan you or someone in your household is eligible for. (You’ll need to fill out this form even for coverage you’re eligible for but don’t enroll in.)

• Any other important information that could affect your health insurance premium or coverage options. Better safe than sorry!

Here is an example of the health insurance exchange application form for individuals.

Here is an example of the health insurance exchange application form for families.

Qualifying for Medicaid Expansion in Texas

At the moment Texas has not approved Medicaid Expansion. Expanding Medicaid would help to cover millions of uninsured Texans.

Texas Health Insurance Exchange Facts

Some of the latest facts on the Health Insurance Exchange in Texas.

Texas will allow HHS to step in and setup and run their Insurance Exchanges.

Texas has not implemented all of the ObamaCare provisions necessary to insure the maximum amount of Texans.

Choosing the Right Health Insurance Plan

There are a number of different tiers of plans available on the Texas Health Insurance Exchange. Plans range from bare bones “bronze” plans which cover 60% of out of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the Texas insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

Health insurance companies do not have to offer every tier of plan, but within the Texas health insurance Exchanges, all health insurance companies must offer at least one silver plan and one gold plan to consumers.

Texas Insurance Exchange: Factors that Affect Rates

ObamaCare does away with pre-existing conditions and gender discrimination so these factors will no longer affect the cost of your insurance. Please be aware location, income, smoking status, family size and age all affect the cost of your health insurance premium. The cost of any their of plan will fluctuate from person to person and from family to family. Please keep this in mind when shopping for insurance on the Texas health insurance exchange.

Choosing a Health Care Plan: How to Calculate the Cost of Health Insurance

To get started you’ll want to figure out what your budget is for health care this year. Affordable health insurance is defined as 8% of your income. Take your income for last year and find out if you can afford to pay 8%, if not find a number that you feel you can pay. Now that you have an idea of what you can afford it’s time to take a look at the Kaiser cost calculator from the Texas health insurance exchange. This will give you an estimate of what you and your family will pay. Keep in mind that health, age and other factors can increase or decrease the cost of your insurance.

How Do I Enroll in the Texas Health Insurance Exchange Marketplace

To enroll in the Texas Health Insurance Exchange Marketplace you’ll use the official website HealthCare.gov to apply for coverage, compare plans, change plans, and enroll. The marketplace is only open during open enrollment.

The Texas health benefit exchange marketplace is open. Make sure to sign up for our newsletter for updates. As we learn more about the exchanges we are updating our site with the latest information on how to use ObamaCare’s official State Marketplaces.

 

Texas Health Insurance Exchange Guide
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