Texas Health Coverage
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Texas Enrollment Dates and Deadlines
In Texas and many other states, the Open enrollment Period to buy or renew your health insurance plan under the Affordable Care Act starts on November 1st.
Enrollment periods for 2024 coverage:
- Open Enrollment Period: November 1, 2023 - January 16, 2024
- Special Enrollment Period: January 17, 2024 - October 31, 2024
If you missed the window of the Open Enrollment Period, you will have to wait until the following year to enroll in health insurance unless you experience a Qualifying Life Event (QLE). See below some examples of Qualifying Life Events:
- Getting married, welcoming a new baby, or adopting a child
- Losing health insurance due to job loss, divorce, or legal separation
- Losing coverage when relocating to a different county or ZIP code
- And many more!
If you experience a Qualifying Life Event, you will qualify for the Special Enrollment Period (SEP). In the case of "Loss of health insurance," it can be 60 days prior to the termination of their plan.
Check out our insurance guide here for more information on health insurance related topics.
Health Insurance Carriers Available in Texas
All these carriers comply with the state and federal requirements mandated by the Affordable Care Act. Every plan provided includes "essential health benefits" such as emergency services, prescription drug coverage, hospitalization, pregnancy, maternity, newborn care, mental health services, and more.
Average Health Insurance costs in Texas
When you're picking a health insurance plan, it's important to know how much you'll be paying throughout the year. HealthBird's AI technology is designed to assist you in discovering plans tailored to your financial needs.
Here's a breakdown of average costs based on last year's Open Enrollment Period in Texas:
$123/mo
$783/mo
$1307
$3214
Insurance Costs Terminology
When considering the cost of a plan, there are several terms you should be familiar with:
- Premium: A premium is the amount you pay, typically monthly, to your insurance company to maintain coverage. It's the insurance policy's cost, regardless of whether you use healthcare services.
- Deductible: This is the amount you're required to pay before your insurance will begin to pay for covered services.
- Out-of-pocket max: This refers to the most you will pay for covered health care in a year. After you hit this limit, your insurance covers 100% of costs for covered services.
- Copayment: Copayments are fixed amounts paid for specific services covered by insurance, often due at the time of service.
- Coinsurance: It is the percentage of healthcare costs you share with your insurance company after you have paid your deductible.
Texas and the Affordable Care Act (ACA)
The Affordable Care Act (ACA), also known as Obamacare, is a law that was passed in 2010 to make health insurance more affordable and accessible for all Americans. Here's how itworks and how it can help you get subsidized or even free health coverage:
1. Easier access to healthcare: The ACA provides a premium tax credit to reduce the monthly premium for health insurance plans. This financial aid is based on your income, family size and geographic location. You may qualify for significant savings on health coverage and in some cases you might even pay nothing for your insurance. HealthBird can help you find subsidized coverage.
2. Additional rights & protections: Before the ACA was signed into law, health insurance companies could deny coverage to individuals with pre-existing conditions and terminate coverage for those who fell ill or required extensive medical treatment. Now, the ACA prohibits health insurance companies from denying coverage or charging higher premiums based on pre-existing conditions. This means you can still get health insurance even if you have a health problem.
3. The Marketplace: The marketplace is also known as the Exchange, a service available in every state to help individuals, families, and small businesses shop for and enroll in affordable health insurance. The Marketplace is accessible through websites, call centers, and in-person assistance, where you can shop for and compare health insurance plans. Even better, you can make this process easier by letting HealthBird help you find the best coverage.
What is Texas Medicaid and How Does it Work in Texas?
When you’re shopping for health insurance, it’s important to understand the difference between Medicaid and the Marketplace to determine which one is right for you. In this section, we’ll go over the Texas Medicaid program, how it differs from the Marketplace, what’s available for children, and eligibility for each one.
What is Medicaid?
Medicaid is a health insurance program that's funded by both the federal government and individual states. It offers free or affordable health coverage to qualifying low-income adults, children, pregnant women, seniors, and individuals with disabilities. The Medicaid program underwent a major expansion in 2014 because of the Affordable Care Act. Each state had the choice to participate in this expansion or not. At present, more than 30 states along with the District of Columbia have chosen to expand their Medicaid programs.
Texas Medicaid Overview:
- The jointly funded federal and state health insurance program provides comprehensive coverage for individuals in need, pooling resources to ensure access to essential healthcare services.
- This program offers free or low-cost coverage to qualifying low-income individuals across various demographics, including adults, children, pregnant women, seniors, and those with disabilities, ensuring that healthcare remains accessible to vulnerable populations.
- Expanded under the Affordable Care Act, eligibility for this program has broadened, focusing on income criteria rather than specific categories, thus extending its reach to more individuals in need of affordable healthcare solutions.
- Mandatory coverage of essential benefits such as physician services, hospital care, diagnostic services, and more ensures that enrollees have access to vital healthcare services, promoting comprehensive care and well-being for all participants.
Medicaid vs. the Marketplace
- Medicaid recipients retain the option to enroll in Marketplace plans, although they might not qualify for specific subsidies.
- As household income increases, individuals may no longer meet the eligibility criteria for Medicaid, thus prompting them to explore Marketplace plans.
- The absence of Medicaid expansion in certain states results in a coverage gap for uninsured individuals.
If you qualify for Medicaid, you can still sign up for health insurance through the Marketplace. However, you may not be eligible for the subsidies provided under the Affordable Care Act: cost-sharing reductions and premium tax credits. As a result, Medicaid typically remains the more economical choice.
If your household income rises, making you ineligible for Medicaid, it's important to consider enrolling in a Marketplace health insurance plan. Additionally, there's a strong possibility that you may qualify for one or both of the ACA subsidies. Discover how much you can save by checking here.
What is the Medicaid gap?
- The Medicaid Gap pertains to uninsured individuals residing in non-expansion states who do not meet the requirements for either Medicaid or ACA subsidies.
- In non-expansion states, the income thresholds for Medicaid can be as low as 44% of the Federal Poverty Level.
- Available coverage alternatives include either purchasing ACA plans at full price or accessing affordable healthcare services through community health centers.
What is CHIP and How does it relate to Medicaid, the ACA, and your family?
- The Children's Health Insurance Program (CHIP) is a state-funded initiative primarily offering health coverage to children from low-income households.
- CHIP addresses the needs of households that do not qualify for Medicaid or lack adequate coverage through employer-sponsored insurance.
- Eligibility criteria for CHIP vary by state, generally encompassing children from households with incomes up to at least 200% of the Federal Poverty Level.
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