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For the second year in a row, Texas has the highest number of people without insurance. The U.S. Census Bureau reports that 2018’s figure of five million people with no health coverage is double the national average, sitting at 17.7%. It’s also one of the 14 states in the U.S. that haven’t expanded Medicaid.
This means it’s more important than ever to understand the options open to you when looking for health insurance in Texas. The process of finding affordable health care plans in the healthcare marketplace and enrolling in plans at the right time can save you on steep medical costs later on.
The new limitations on health insurance mean Texans have to be more organized when considering their options. Your first step is to understand whether to choose ACA-compliant health plans, non-ACA plans, or short term health insurance in Texas.
Accessing ACA-Compliant health insurance plans through Texas health markets is the most popular and convenient option for consumers. However, you will still have your work cut out for you. Your search is bound to be a negotiation between the cost of coverage and your personal medical requirements.
To keep things simple, there are three tiers of coverage under ACA-Compliant health insurance plans. These include:
What it covers: Bronze plans feature cost-effective monthly premiums. However, high out-of-pocket costs offset these low payments. The deductibles and out-of-pocket maximums are near or at the highest amount allowed by law. For example, in 2020, this would be $8,100 for an individual and $16,200 for a household.
Who it’s for: The lower premiums are appealing, but the high out-of-pocket costs make it very clear – Bronze and catastrophic plans are intended for youth and individuals who are generally in good health. They rarely, if ever, have to visit the emergency rooms, and they experience no chronic or ongoing health issues. Bronze health insurance coverage works best in cases of emergencies. If you had to rack up a sudden, large bill because of a serious accident, this would cost tens of thousands of dollars. A Bronze plan would kick in and really give you your money’s worth in this case.
What it covers: Most individuals go for Silver plans because they are the most affordable options for health care in Texas. However, these middle-of-the-way plans are also the ones that experience the most substantial changes to premiums. By contrast, Bronze and catastrophic plans in Texas experienced a rate decrease over two years. These plans are the only ones in the metal line-up that come with a cost-sharing reduction variation. This allows households to take advantage of lower copays, deductibles, and coinsurance.
Who it’s for: Silver plans work well for low-income to average-income households and individuals. Households with an income that is less than 250% of the federal poverty level can use a Silver plan to get the most out of their insurance.
What it covers: Gold plans have much lower copays, coinsurance, and deductibles when compared to standard plans. The monthly premiums are higher overall, but these are hard-working plans if the individuals opting for it truly need and use medical services on a routine basis.
Who it’s for: The out-of-pocket expenses you’ll pay for on a Gold plan are significantly lower, if not entirely negligible. If you’re someone who frequently requires prescription medication, this is a significant benefit. Prescription medication is typically the area of any plan with the highest routine use. Consumers who expect that they will require frequent access to medical care and expensive procedures will benefit most from the Gold plan.
In Texas, your age directly impacts the premiums you will pay for health insurance, and you can use this to your advantage to move between tiers of coverage.
ACA-Compliant plans have certain requirements they must meet to qualify as such. These are known as “Minimum Essential Coverage” or MEC, and the list includes 10 services the ACA thinks are absolutely essential to healthcare in Texas. Coverage for pre-existing conditions is also a standard part of ACA plans.
Short-term plans are temporary solutions for those who wish to save money on medical care. These plans offer temporary medical coverage and are often used as a kind of bridge to medical care access before the individual shifts to a different health plan.
While short term health insurance in Texas calls for a lower up-front cost, these plans also offer less coverage in kind. Keep in mind, as well, that health marketplaces don’t offer short term health insurance in Texas.
Individuals who use short term health insurance have a maximum initial term of 12 months (364 days). After this, they will need to purchase a new short term plan, or consider an ACA-compliant plan or choose a plan from a private insurer.
From November 1st to December 15th, individuals and families can pick their insurance providers and plans. This is the process of open enrollment, and it encourages consumers to re-assess their health needs each year. There are also instances when you can enroll outside of this time period.
At iHealth Agents, we simplify the process of applying for affordable health insurance in Texas. Both ACA-compliant and non-ACA plans are accessible through our convenient marketplace technology. Gain direct access to carrier feeds for pricing, enrollment, and service. Chat with one of our live care specialists or visit AHix Marketplace to learn more about our easy enrollment process for affordable health insurance in Texas.