TABLE OF CONTENTS
You may struggle to pay for health care in Texas, as the state ranks dead last for affordability and access to health care in The Commonwealth Fund’s 2020 Scorecard on State Health System Performance. When affordability is a significant concern, a good health insurance plan can help.
Read on to learn about your options for Affordable Care Act plans, Medicaid, Medicare, CHIP, and other pathways to insurance for Texans. This guide explains how you can get health care coverage, the cost of coverage, and how to find the best plan for you or your family’s health care needs.
If you want to enroll in an ACA plan in Texas, you’ll need to visit Healthcare.gov. First, you must create an account for yourself and any family members. You’ll provide personal information, including your address, phone number, Social Security number, marital status, household income, and the number of people in your household. Once you’ve completed this step, Healthcare.gov will determine your eligibility for Medicare or a premium tax credit. You’ll then choose from available health plans and can compare as many as three at a time. There are currently 10 companies that offer health insurance coverage on the ACA marketplace in Texas:
Whether you’re selecting a plan on Healthcare.gov or buying a plan for yourself or multiple people, you should consider the following:
When selecting a plan, you can choose from several different options for the network of doctors you have access to and how you receive the health care.
When selecting health care for your family, the questions become more complex. You may be healthy, but if your spouse or one of your children has a chronic health problem, it’s a bit trickier to balance how much you can pay for your health insurance and how much coverage you’ll receive. If your family is healthy and you don’t make many trips to the doctor, consider a lower-cost premium with a deductible and max out-of-pocket you can afford in the event of a catastrophic medical issue. If a family member does have a chronic health issue, a plan with a higher monthly premium and a lower deductible might be a better option. Keep in mind that it’s possible to have separate policies for family members depending on their level of need for coverage.
The Texas health insurance marketplace offers plans that work on the metal tier system: Bronze, Silver, Gold, and Platinum. Every tier provides ACA-compliant coverage but differs in the percentage of coinsurance and deductibles, which dictate your out-of-pocket costs. Some have higher premiums; some have higher deductibles. Consider a balance of an affordable monthly premium offset against your out-of-pocket expenses when you visit the doctor or have a catastrophic event.
|Average premiums in Texas||2018||2019||2020||2021||2022|
|Most affordable Bronze plan||$309||$313||$295||$301||$306|
|Most affordable Silver plan||$419||$422||$418||$420||$415|
|Most affordable Gold plan||$461||$496||$471||$429||$403|
Texas offers Medicaid and CHIP for individuals and families with low income.
Texas Medicaid eligibility has financial and demographic requirements. Find out if you may qualify for Medicaid in Texas. To be eligible for Texas Medicaid:
You must belong to at least one of the following categories:
Income limits are $25,503 for an individual, $34,492 for a couple, and $43,481 for a family of three.
Even if you don’t qualify for Medicaid, your children may receive coverage through CHIP. Services covered include regular checkups, dental service, immunizations, hospitalizations, X-rays and lab tests, vision and hearing, mental health care, access to specialists, and treatment of pre-existing conditions.
Income limits are $2,158 per month for an individual, $2,918 per month for a couple, and $3,679 per month for a family of three.
If you’re at least 65 or have a qualifying disability, you may be eligible to receive Medicare, the federal government’s health care program for seniors and the disabled.
A Medicare Supplement Insurance plan (Medigap) is a great way to deal with the extra costs associated with Original Medicare. It covers deductibles, copayments, and coinsurance. It can also provide coverage if you’re traveling outside the U.S. It doesn’t cover vision, hearing, or dental, nor does it cover any long-term care costs. Medigap doesn’t work with a Medicare Advantage Plan.
To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
If you need help with Medicare, there are resources in Texas that can provide guidance.
The Texas Health Information, Counseling, and Advocacy Program provides resources for Medicare beneficiaries, their families, or their caregivers. You get free, unbiased, and confidential counseling about a wide range of Medicare issues and other health care options available.
Yes, you can purchase short-term health insurance in Texas. Plans can last for up to 364 days and can be renewed three times. Short-term health insurance is designed for people under 65 and in good health who are between jobs or waiting for the marketplace Open Enrollment Period. These plans are limited, don’t provide coverage for pre-existing conditions, and don’t cover pregnancy, mental health concerns, or prescription drugs. The plans are primarily designed to cover emergency health situations during a coverage gap and usually cap how much the insurance company will cover.
Federal law requires all U.S. citizens to carry health insurance, but there’s no longer a tax penalty for not having insurance.
You can buy a plan off-exchange from several providers in Texas or purchase short-term insurance. You’ll need to use the marketplace if you want a premium tax credit or want to apply for Medicare.
The most popular form of cost-sharing plan is a faith-based program. These plans share costs between members and are relatively inexpensive. You typically don’t need to be a member of a particular denomination to sign up for a plan. Many of these plans don’t cover pre-existing conditions or other essential health benefits guaranteed under ACA plans. Before you sign up for a cost-share program, make sure it provides coverage in the areas you need. Most cost-sharing plans aren’t legally obligated to pay out claims as the programs aren’t health insurance.
In most cases, yes. It’s almost impossible to save enough money under a health savings account (HSA) or flexible savings account (FSA) plan to pay for a significant medical expense or unexpected catastrophic events. HSA and FSA plans can help pay for out-of-pocket costs like deductibles, copays, and coinsurance.
Yes, depending upon the nature of your job. Short-term disability coverage covers regular household expenses like your mortgage, utilities, or groceries when you’re injured. Health insurance won’t cover these costs. If there is a risk of injury with your job, you should consider a short-term disability plan.
Long-term disability covers the same costs as short-term disability. Health insurance won’t pay for these costs. If you work in a potentially dangerous job where an injury is possible like construction or roofing, a long-term disability plan is a good idea.
CHIP provides health care to children from families in Texas with low or no income. Services covered include regular checkups, dental service, immunizations, hospitalizations, X-rays and lab tests, vision and hearing, mental health care, access to specialists, and treatment of preexisting conditions.