Updated on September 22, 2017
Texas does not run its own state-based health insurance exchange. Instead, residents here use the federally facilitated site at HealthCare.gov. They can also use an independent agent, broker site or company to enroll directly while still taking advantage of cost-saving measures under the Affordable Care Act (Obamacare).
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Requirement by Law
Despite the political upheaval this year over healthcare reform, it’s important to note that Obamacare’s individual mandate is still in effect. The IRS has stated that it will be enforcing the mandate as well. Under the Affordable Care Act, all eligible Americans – which represents much of the country – must hold qualifying health insurance or face a penalty fee. For this year, the fee is the greater of 2.5 percent of your household’s taxable income or a flat fee of $695 per adult ($347.50 per child under 18). The fee increases with inflation each year.
Enrollment in Texas
During the 2017 open enrollment period, 1,227,290 people signed up for health insurance using the state exchange, compared to over 1.3 million last year. The shift downward in enrollment can be contributed to several factors, including uncertainty over the current administration’s stance on healthcare reform and rising premium costs. Despite the decrease in signups, Texas has the third-highest exchange-based enrollment after Florida and California.
While Texas enrollees can use the federal marketplace site for enrollment, it may be beneficial to shop around using a comparison site like this one. Getting current quotes from multiple carriers can help you find a plan that adequately addresses your needs and fits your budget. Brokers can also help explain your options more clearly.
In 2018, customers in Texas will be able to choose from eight carriers on the exchange, losing two from the previous year (Humana and Prominence).
- Ambetter (Celtic)
- Blue Cross Blue Shield of Texas
- CHRISTUS Health
- Community Health Choice
- FirstCare (SHA)
- IdealCare (Sendero)
Plan options from these insurers will vary across the state, but most Texans can expect to choose from one to three carriers. Two counties in the Lone Star State (Jefferson and Burnett) will have more than three insurer options. Premium rate increases for 2018 will also vary, ranging from 15 to just under 43 percent. Texas insurers have assumed that cost-sharing reduction payments will continue for 2018. If CSR payments are not guaranteed, then premiums are likely to increase even further.
For lower- and middle-income families and individuals – those earning between 100 and 400 percent of the federal poverty level – there are provisions in place for financial assistance, including tax credits and subsidies. Approximately 83 percent of exchange customers in Texas qualified for premium subsidies in 2017. For more information about federal financial assistance, start the enrollment process today. Open enrollment for 2018 runs from November 1, 2017 to December 15, 2017 this year.
Texas is one of 36 states that relies on the federal health exchange (the Marketplace) for its healthcare coverage. However, in January 2015, Texas State Representative Chris Turner, a Democrat, filed two bills designed to establish a state-run exchange. These bills, which both centered on the recent Supreme Court case (King v. Burwell), both failed. Considering that the Supreme Court ruled in favor of continuing federal subsidies, this removed much of the need for a state-run exchange.
Texas residents can turn to the federal Marketplace’s website, www.Healthcare.gov, to research and compare direct quotes from various brokers and providers, including plans offered by privately owned and for-profit companies. And, purchasing any of these policies means that you are meeting the requirements of the Patient Protection and Affordable Care Act (ACA).
Also known as Obamacare, this healthcare law requires Americans to purchase health coverage during the annual Open Enrollment Period (OEP), which runs from Nov. 1, 2015 to Jan. 31, 2016. If you miss this deadline, you may face an IRS-imposed penalty.
Texas’ impressive ACA enrollment rates
The U.S. Department of Health and Human Services (HHS), which oversees the ACA, found that 1,205,174 Texans enrolled through the Marketplace during the 2015 OEP; this is the nation’s third-highest rate. 57 percent of these enrollees are actually first-time customers.
In addition, the agency found that 146,548 people enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) during the 2015 OEP. CHIP is a federal program providing free or low-cost coverage to children and other family members. This is important, as Texas has been shown to have the highest number of Medicaid enrollments among states that haven’t expanded Medicaid.
Further evidence of Obamacare’s benefits of Obamacare for Texas residents is illustrated by the HHS’s enrollment studies. In 2014, 84 percent of all residents enrolling through the Marketplace qualified for tax credits. The HHS found that in 2014, Texans had the seventh-lowest monthly premiums among the 36 states utilizing the federal Marketplace.