Texas is the second-largest state in the U.S., and its “everything is bigger in Texas”-motto translates to health insurance as well. Residents of The Lone Star State residents can buy a multitude of policies to help cover doctors, hospitals, accidents, and illnesses.
If you don’t have employer-sponsored health coverage, you can buy your own plan from the Health Insurance Marketplace or from other private online exchanges. You can also apply in person or by phone.
What Are Your Options for Texas Health Insurance?
Affordable Care Act in Texas
The Open Enrollment Period is November 1 – January 15 each year. Today, there are five different insurance carriers offering Texas health insurance Obamacare plans.
These plans have 10 essential health benefits required by law. Services include:
- Outpatient care without being admitted to the hospital
- Emergency services
- Pregnancy, maternity and newborn care
- Mental health and substance abuse services
- Prescription drugs
- Rehabilitation services and devices
- Laboratory services
- Prevention and wellness services
- Pediatric services, including childhood dental and vision care
ACA plans have different tiers of benefits, which are named by “metal” level: bronze, silver, gold, and platinum. Each tier varies by how much medical services you pay after you reach your deductible.
For example, bronze plans pay 60% of medical services compared to platinum plans, which pay 90%. (Every health insurance plan has a deductible, which is the amount of money you’re responsible for before your insurance company begins paying for the majority of your coverage.)
You can also enroll in catastrophic plans, which are for individuals under the age of 30. But you won’t qualify for a financial subsidy.
If you’re under 30 and eligible for a subsidy, a Bronze or Silver plan could save you more money. A majority of Americans who apply for ACA plans qualify for a tax subsidy to lower monthly health insurance premiums or costs.
The 2021 American Rescue Plan expanded subsidy eligibility for all Americans through 2022. Even if you already receive subsidy dollars, you could qualify for more assistance, so it’s a good idea to check with the federal Marketplace.
Medicare in Texas
Medicare’s insurance is for seniors 65 and older, although some people with disabilities can qualify before age 65. Run by the federal government, Medicare pays for approximately 80% of doctors and hospitals. Generally, Part A is provided at no cost, while the other benefits are available with premium payments.
You can add a Medicare supplement policy to help cover the 20% coverage gap. You can also give up your Original Medicare plan and enroll in Medicare Advantage, which adjusts pricing based on income and includes extra coverage like dental, vision, and prescription drugs.
Medicaid and CHIP
Medicaid is health insurance coverage for low-income adults, pregnant women, elderly adults, and people with disabilities who qualify. Medicaid is administered by the state of Texas according to federal regulations but funded by the state and federal government.
Texans have access to Children’s Medicaid or the Children’s Health Insurance Program (CHIP), depending on qualification. It cares for medical needs from birth to 18 years of age. In some instances, 19 and 20-year-olds with disabilities also qualify.
To be eligible for Medicaid, you must be a Texas resident, a U.S. citizen, or a qualifying non-resident in need of health insurance assistance. Your financial situation would also be characterized as low income. Lastly, you must be:
- Responsible for a child 18 years of age or younger
- Have a disability or a family member in your household with a disability
In some instances, you can be 65 or older and qualify. To do so, your income cannot exceed $25,503 before taxes. This number increases based on household size.
Short-Term Health Insurance in Texas
Short-term medical insurance is temporary coverage that provides some financial protection when major medical insurance isn’t available. These plans are popular for their budget-friendly pricing; however, they are not required to cover the same costs and treatments as ACA plans.
While most preexisting conditions aren’t covered, Texas does require coverage for certain preventive and preexisting conditions like colorectal cancer screenings, hearing aids, pap smears, and more.
Health Insurance Costs in Texas
Affordable Care Act: An unsubsidized average benchmark premium of an ACA health plan in Texas costs $436 per month, which has remained constant since 2018.
Medicare: Medicare Part A (hospitalization insurance) is free. The base rate for Medicare Part B (doctor insurance) is $148.50. However, costs vary based on income. They also change if you choose an additional supplemental plan or waive your Medicare coverage for Medicare Advantage.
Medicaid: Texas Medicare includes free and subsidized options based on total household income and family size. There is also a Medicaid Buy-In program that offers low-cost Medicaid services to adults with disabilities who work.
Short-Term Health Insurance: For a 30-year-old woman in Dallas, plans range between $106 per month to over $525, depending on the plan selected. Your age, ZIP code, county, and gender all play a factor in the final pricing.
Enrolling in Texas Health Insurance
Here are some specifics for enrolling in Texas health insurance:
Affordable Care Act
You can enroll in Obamacare coverage online, over the phone, or face-to-face with an agent or Navigator. You can also get an estimate for how much you could get in terms of a financial subsidy. You will need to create an account at HealthCare.gov to find out how much you can save with a subsidy.
If you don’t qualify for a tax subsidy, you can buy a policy from a private marketplace online or directly from a health insurance company. Feel like you might need a little help? Contact a licensed agent in your area over the phone to learn what options are the best for your situation.
If you want to speak with someone in person, consider making an appointment with an ACA plan Navigator or an insurance broker.
If you qualify for Medicare, you might already have Plan A. But you do need to enroll in Plan B, which can be done from Medicare.gov.
If you want to check out Medicare Advantage or would like to add a supplemental plan to your Original Medicare plan, you can reach out to a private health insurance carrier or insurance agent to get more information.
As many over the age of 65 are delaying retirement, some people may wonder, “Can I drop my employer health insurance for Medicare?” If you are already covered on a group health plan, you may not need to get Medicare coverage.
As a general rule, you will be charged a late fee if you don’t apply for Medicare when you first become eligible but then apply for it later. However, you can apply for a delay in coverage if you would like to remain on an employer plan.
Medicaid and CHIP
Medicaid and CHIP programs can be accessed through Texas Health and Human Services. From there, you can learn more or get help with other community programs in person. To apply online, visit yourtexasbenefits.com.
Short-Term Health Insurance
Short-term health plans are found online from private health insurance carriers. Once you have reviewed plan types and the exclusions and limitations, enrollment takes five minutes or less.
Applying for a health policy takes time, but you can find the best plan for your needs with a little research. To navigate the insurance landscape, ask yourself these questions:
- Do you qualify for an ACA plan subsidy? Nearly 90% of Americans do. Find out what your monthly premium costs would be.
- Are you low-income with children? You might qualify for Medicaid benefits.
- Are you 65 or older? You automatically qualify for Medicare but need to make additional decisions on whether to add supplemental coverage to your Original Medicare or switch to Medicare Advantage.
- Do you need temporary coverage right now? A short-term policy can keep you from being uninsured while deciding the next steps.
Set time aside to consider your options and do the research. You could save yourself a lot of money by securing a health insurance plan that is just right for you.
Bio: Colleen McGuire is an independent consultant who has spent most of her career writing about healthcare and the health insurance industry. For fun she blogs, travels and takes a lot of pictures along the way.