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Affordable Texas health insurance  Texas Health Reform Center Texas health exchange

Texas Health Insurance Exchange Overview

Effective January 1, 2014 health insurance exchanges will begin to provide health insurance coverage options for consumers. A health insurance exchange is not a health insurance carrier but an inventory of standardized plans that are subject to government regulations. Individuals and employers will have access to health insurance exchanges to purchase coverage that is eligible for federal subsidies. Each state is required to establish a health insurance exchange. If the state elects not to establish a health insurance exchange, the federal government can create an exchange to serve the consumers in that state. Texas health insurance carriers will have the option whether to market coverage within the exchange. The adopted acronym for health insurance exchange is HIX.

President Obama promoted the concept of a health insurance exchange as a key component of his health reform initiative. Obama stated that it should be "... a market where Americans can one-stop shop for a healthcare plan, compare benefits and prices, and choose the plan that's best for them, in the same way that Members of Congress and their families can. None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention and protection against catastrophic costs."

The exchanges will provide four levels of coverage designated as metallic plans and categorized by actuarial value. Actuarial value is defined as the amount of healthcare expenses that the plan will be responsible for paying. The insured will be responsible for the remaining amount through payment of deductibles, coinsurance and copays. The plans are named platinum, gold, silver and bronze. Platinum plans will have an actuarial value of 90%, gold will have an actuarial value of 80%, silver will have an actuarial value of 70% and bronze will have an actuarial value of 60%. The exchanges will offer a catastrophic plan that is limited in benefits and will only be available to individuals under the age of 30 or to those with financial hardships.

Exchanges are expected to be operational by October 1, 2013. Applications that are submitted between October 1, 2013 and December 15, 2013 will be assigned a January 1, 2014 effective date. After December 15, 2013, open enrollment will begin and continue until March 31, 2014. Applications that are submitted between the first and fifteenth day of the month will have the first day of the following month assigned as the effective date. If the application is submitted between the sixteenth and the last day of the month during open enrollment, the coverage effective date assigned will be the first day of the second following month.

Individuals insured through the exchange will be eligible for premium subsidies, also known as premium tax credits, if they meet certain income requirements. For consumers who are between 100% and 400% of the federal poverty level (FPL), health insurance premium cost will be based on a percentage of their income.
 

Income Level Annual Premium Not To Exceed Percentage of Income
Up to 133% FPL 2% of income
133 to 150% FPL 3 to 4% of income
150% to 200% FPL 4 to 6.3% of income
200 to 250% FPL 6.3% to 8.05% of income
250 to 300% of FPL 8.05% to 9.5% of income
300% to 400% FPL 9.5% of income


Federal poverty limits vary by family size. The following table illustrates the income that falls between 100% and 400% of FPL depending on family size.
 

Family Size Income Between 100% and 400% FPL
Individual $10,830 to $43,336
Family of 2 $14,470 to $58,280
Family of 3 $18,310 to $73,240
Family of 4 $22,050 to $88,200


For those individuals who purchase health insurance through the exchange and meet income levels between 100% to 250% of the federal poverty level, cost sharing assistance will be provided. In order to qualify for cost sharing, in addition to meeting the FPL requirements, the individual must enroll in at least a silver plan. For individuals with incomes between 100% and 200% of the FPL, a 2/3 reduction in premium will be available. For the remaining individuals between 200% and 250%, the reduction will be either 1/2 or 1/3 depending on income.

Additional benefits will be available to individuals under 250% of the FPL. Individuals with incomes between 100% and 150% of FPL will benefit from plans with an actuarial value of 94%. Those with income levels between 150% and 200% will be insured by plans with an actuarial value of 87%. Insurance coverage will be offered at 73% actuarial value for individuals with annual income of 200% to 250%.

You can run your Texas Health Exchange Quote here to view rates and plans side by side from the major carriers...Free.

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If Your Income
Is In This Range

Current Years Estimate; All those that file together on one 1040 tax form:


Single Person: $11k - $47k
2 People $16k - $63k
3 People $20k - $79k
4 People $24k - $95k

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