Obamacare in Texas

Download PDF

Health Insurance Marketplace in Texas

If you live in Texas, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Specific plans and prices are available now and coverage can start as soon as January 1, 2014.

Spanish language speakers can contact cuidadodesalud.gov.

Choosing the Right Health Insurance Plan

There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.

Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.

Expanded Medicaid

Texas has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Texas’ current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.

Who can help you (the Navigators)

Get local help

United Way of Metropolitan Tarrant County

United Way of Metropolitan Tarrant County has served the people in the Fort Worth and Arlington area of Texas for over 90 years. In collaboration with 17 organizations, United Way of Metropolitan Tarrant County will work across the state to promote enrollment in the Marketplace.

Migrant Health Promotion, Inc.

Migrant Health Promotion improves health in farmworker and border communities in Florida, Michigan, Ohio, Washington, and South Texas. This project will focus on enrolling and educating migrant populations in the Rio Grande Valley of Texas.

National Hispanic Council on Aging

National Hispanic Council on Aging (NHCOA) works closely with its Hispanic Aging Network composed of 39 community-based organizations across the continental U.S., the District of Columbia, and Puerto Rico. The NHCOA will deploy Navigators in Dade County, Florida, and Dallas County, Texas, to enroll the uninsured Hispanic population in these two counties with a focus on members of this population that are socially isolated due to cultural and linguistic differences.

Change Happens

Change Happens is a non-profit located in Houston, Texas, with experience in conducting community engagement through education, outreach, and developing dynamic relationships with community members. The goal of the project is to provide trained Navigators with expertise in eligibility and enrollment rules and procedures to conduct public education and
outreach activities that result in 98,891 uninsured individuals enrolled in affordable health insurance.

United Way of El Paso County

United Way of El Paso County has served residents of El Paso, Texas for over 90 years. Through the Enroll El Paso project this grant will provide training to people to work with the community and provide education and assistance with Marketplace enrollment.

Southern United Neighborhoods

Southern United Neighborhoods is a public charity that uses research and training to combat poverty. Southern United Neighborhoods Navigators will provide expertise in eligibility, enrollment and program specifications of Affordable Insurance Exchanges in Arkansas, Louisiana and Texas; implement comprehensive outreach and public education to over 835,000 low to moderate income residents who are likely to be eligible for enrollment in a QHP; and coordinate with community groups, employers, faith-based groups and state agencies to integrate outreach efforts.

East Texas Behavioral Healthcare Network (ETBHN)

The East Texas Behavioral Health Network (ETBHN) will serve the uninsured, underinsured, and self-employed population in 75 counties in Texas. This program will assist this population with understanding new healthcare programs, taking advantage of consumer protections, and navigating the health insurance system in order to find the most affordable coverage that meets their needs.

National Urban League

The National Urban League Navigators plan to conduct outreach and enrollment predominantly in areas that have low-income, medically underserved, urban residents in Texas.

Who you can contact for more help

Information for:

Individuals and Families

Small businesses

If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know  with the form below and we’ll get right back to you.

[contact-form-7 id=”73″ title=”Contact form 1″]

Subscribe to the Obamacare-enrollment newsletter

Accountable Care Organizations in Texas

ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.

Health care facilities where Innovation Models are being tested

The Insurance Exchange/Marketplace

What has been done, not been done, or left up to the federal government to do.

Establishing the Exchange in Texas

On July 9, 2012, Governor Rick Perry (R) announced that Texas would not establish an exchange.1 Prior to this announcement, the Department of Insurance and the Health and Human Services Commission had partnered to explore exchange implementation plans.2 Using federal grant funding they identified subcontractors to assist with the exchange planning process, to collect stakeholder feedback, and to investigate the state’s policy options. In addition, Texas held a public exchange planning symposium and solicited public comments in early 2011.3

Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. In August 2012, the Texas Department of Insurance held a public forum to discuss stakeholder feedback on the possible EHB benchmark plans.4 Texas did not put forward a recommendation and the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Texas- BestChoice PPO.

Exchange Funding

The Texas Department of Insurance received a federal Exchange Planning grant of $1 million in 2010, though the state has since returned $900,000 of this grant to the federal government.5

Expansion of Medicaid

From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.

As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.

However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.

Texas is not participating in Medicaid expansion.

Next Steps

The federal government will assume full responsibility for running a health insurance exchange in Texas beginning in 2014.


1. Press Release from Governor Rick Perry. “Gov. Perry: Texas Will Not Expand Medicaid or Implement Health Benefit Exchange.” July 9, 2012. http://governor.state.tx.us/news/press-release/17408/
2.Ramshaw E. “Perry Rejects ‘Obamacare,’ But State Agency Pushes On.” The Texas Tribune. June 20, 2011.http://www.texastribune.org/texas-health-resources/health-reform-and-texas/perry-rejects-obamacare-but-state-agency-pushes-on/
3. “Federal Healthcare Reform- Exchange Planning Symposium. Background Information and Requested Stakeholder Input.” February 14, 2011. http://www.tdi.texas.gov/health/documents/background.pdf  (Access August 15, 2011)
4. Texas Department of Insurance. “Essential Health Benefits.” (Accessed September 5, 2012).http://www.tdi.texas.gov/health/documents/ehbsummary.pdf
5. Tan, Thanh. “Health Leaders Say They’re Ready for Federal Reforms.” The Texas Tribune. February 27, 2012.http://www.texastribune.org/texas-state-agencies/health-and-human-services-commission/will-texas-implement-federal-health-care-reforms/

Also of interest

Provided by the Henry J. Kaiser Family Foundation

 

0 comments on “Obamacare in Texas
14 Pings/Trackbacks for "Obamacare in Texas"
  1. […] Information about expanded Medicare benefits […]

  2. […] Information about expanded Medicare benefits […]

  3. […] Information about expanded Medicare benefits […]

  4. […] Information about expanded Medicare benefits […]

  5. […] Information about expanded Medicare benefits […]

  6. […] Information about expanded Medicare benefits […]

  7. […] Information about expanded Medicare benefits […]

  8. […] Information about expanded Medicare benefits […]

  9. […] Information about expanded Medicare benefits […]

  10. […] Information about expanded Medicare benefits […]

  11. […] Information about expanded Medicare benefits […]

  12. […] Information about expanded Medicare benefits […]