Due to the Affordable Care Act (ACA), also known as ObamaCare, Texans have new options when it comes to accessing health insurance. In addition to new plans, new rules surrounding health insurance plans mean that children can be carried on parents’ policies up through age 26, and as of 2014 new insurance plans cannot deny coverage due to existing health conditions. As of 2014, new health insurance plans in the individual and small group markets will also cover 10 essential health benefits.
While the state did not choose to move forward with a state-run Texas health insurance exchange, Texans will be able to fill out an application and purchase health insurance through the federal Marketplace. The Marketplace application will automatically be reviewed for any applicable tax credits and financial assistance, as well as eligibility for Medicaid and the Children’s Health Insurance Program (CHIP).
Applying for Health Coverage in the Marketplace
When you apply for coverage in the Marketplace, you will be notified if you and your household qualify for either private insurance coverage, including any assistance with premiums or out-of-pocket costs based on your income, or Medicaid or CHIP.
An application in the Marketplace can be filled out in one of four ways: a paper application through the mail, over the phone, online, or in person with a trained assister.
Private Insurance Coverage
The Marketplace allows Texans new opportunities when applying for health insurance. Once an application is completed, plans can be compared side by side. This will allow residents to see the premium cost and cost-sharing amounts for each plan.
Individuals and families in Texas who earn between 100% and 400% of the federal poverty level will be eligible for some kind of financial assistance with insurance premiums. Additionally, those earning between 100% – 250% of the federal poverty level may be eligible for assistance with cost-sharing, such as deductibles and copayments. In 2013, the federal poverty level was $23,500 for a family of four. For an estimate of whether a particular family or individual might qualify for tax credits, Texans can review the Healthcare.gov Quick Check Chart. However, only by making a full Marketplace application can the exact amount of the credit be known.
Medicaid and CHIP
Medicaid provides health coverage for those with low income, families with children, pregnant women, the elderly, and people with disabilities. CHIP provides low-cost health coverage to children in households that earn too much money to qualify for Medicaid.
An application that is submitted through the Marketplace will automatically be reviewed for eligibility for Medicaid and CHIP, and will be transferred to the state agency if applicable. In addition, Texans can contact the state Medicaid agency directly to apply.
Health Care Without Insurance
Because Texas chose not to expand Medicaid eligibility to people with higher incomes, some Texans will find that they make too much to qualify for Medicaid, but not enough to receive assistance with the costs of Marketplace coverage, which is only provided to those earning between 100% and 400% of the federal poverty level.
Therefore in some cases, Texans will find themselves without health insurance coverage despite the new options. In order to avoid a tax penalty, it is important for these residents to apply for an exemption if they cannot afford health insurance. There are many circumstances that may cause the government to grant a health insurance exemption. For more details, visit the Healthcare.gov exemptions page.
For those remaining without coverage, Texans can still take advantage of community health centers to obtain low-cost health care. ObamaCare expanded funding for these community health centers, and many of them have fees that are on a sliding scale based on income. For more information and to find a center near you, visit the Healthcare.gov Community Health Centers page.
Texans have new health insurance and health care options due to the ACA. Plans can now be bought through a central marketplace and compared side by side so that citizens can choose the most appropriate health insurance for themselves and their families.