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2019 Texas Health Insurance OPEN ENROLLMENT


Open Enrollment has rolled around again.


The next Open Enrollment period for the Affordable Care Act (ACA) is between November 1 and December 15 for a January 1 effective date. And it’s time to get ready! At Stateside, we have monitored healthcare reform since it was signed into law in March 2010 and will be ready to explain all the options available to Texans.


As in previous years we’ll be writing applications for On Marketplace and Off Marketplace coverage and plan to have premiums and plan descriptions available for quoting by late-October for the January 1 effective date.


What About Subsidies?


Thanks to the Supreme Court’s King v. Burwell decision, On Marketplace plans remain eligible for premium subsidies and will be available through Stateside. Apply using the 10 Minute Subsidy Application. Our new online On Marketplace enrollment will allow for smoother, speedier enrollment, with subsidy applications completed in less than 10 minutes – versus the previous 45-90 minutes.


Individuals and families, who do not have access to employer sponosred coverage and who meet defined income requirements will be able to receive immediately premium subsidies to reduce the cost of health insurance premiums. The goal of the subsidies is to help consumers who cannot access affordable coverage from employers or the private insurance market.


Income Eligible For Subsidy


In order to be eligible for the subsidies and assistance with out-of-pocket expenses, an individual or family’s gross income will be compared to the federal poverty level (FPL). The level of assistance will be determined by the percentage of gross income to the FPL as determined by number of family members. For example, in 2019 the FPL is $12,140 for a one-person household and rises by $4,320 for each additional family member. The FPL for a four-person family is $25,100. The FPL benchmark is adjusted for inflation each year.


Subsidies will be available according to ACA rules for individuals and families with incomes ranging from 100% to 400% of the FPL. The subsidies will be used to reduce the premium cost for health insurance coverage offered within the health insurance exchanges.


Health insurance plans offered within the exchange consist of three levels of coverage designated as metallic plans because they are titled bronze, silver, and gold. Each plan has a different actuarial value, which is the percentage of costs each plan will cover. For example, bronze plans will have an actuarial value of 60%, which means the plan will cover 60% of healthcare costs, and the remaining 40% will be the responsibility of the insured. Silver plans will provide an actuarial value of 70% and gold plans have an actuarial value of 80%.


The premium for the silver plan will establish the level at which subsidies will be accessed. Since healthcare costs vary from state to state, silver premiums will also vary depending on the state. The percentage of premium paid by the insured will be tied directly to the individual’s actual income as a percentage of the FPL. For example, individuals and families with incomes at 133% of the FPL will be required to pay 2% of their income toward the health insurance premium.


The following is a list of FPL percentages and the percentage of income that the policyholder must pay for health insurance premium.


Income Level Annual Premium Not To Exceed Percentage of 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


To illustrate the health insurance premium cost for plans in an exchange, assume a family of three had an income of $40,180. The FPL for this family would be $20,090 so their income places them at 200% of the FPL. The family would be required to pay 6.3% of their income or $2,531 towards the premium cost of the plan. Using the silver plan annual premium of $12,000 as the benchmark, the premium paid by the family would be $2,531 and the remaining $9,469 would be paid as a subsidy. The family can purchase any plan available from the exchange and use the $9,469 of earned subsidy to reduce the annual premium cost.


Need-To-Know Info


Open Enrollment in 2018 will be the same as 2018 with a 45-day enrollment window. In addition to Open Enrollment for health insurance, there’s Medicare Part D enrollment, which runs from October 15 to December 7.


To add to the complexity, most current ACA plans will not meet the new mandates established by the federal government for 2019 and those policyholders will need to new polcies to replace the outdated policies.


How You Can Prepare: Early Is Best!


Last year’s Open Enrollment was much smoother than expected but the shorter window definitely results in enrollment logjams, especially when everyone’s rushing to meet the deadlines. Start early.


To help you better manage Open Enrollment, email your information to us at


  • Health insurance.Tell us about your healthcare providers. What physicians and hospitals are important to you? This information will allow our Stateside Team to identify health insurance that provides the strongest network participation. 
    • Prescription Information.Send us your ongoing prescription requirements. As you may know, carriers maintain formularies – lists of prescriptions eligible for benefits under their insurance plans. Our team will analyze your prescription requirements to determine the coverage providing the most favorable prescription benefit.


The sooner you provide your information, the easier Open Enrollment will be for you!


Stateside Insurance Services has helped Texans understand the complexities of health insurance since 2003. Feel free to contact our Stateside Team by email at or call us at (866) 444.3332 to discuss your coverage situation and to determine how healthcare reform will affect your coverage options.

Online Phone Appointment Available


In order to be accessible to answer questions and discuss plan options, Stateside has implemented an online appointment tool. Please click on the following link and request a time for a phone appointment with a member of our staff. 


Phone Appointment Link


By using the appointment link, you can schedule health insurance discussions when it is convenient for your schedule and Stateside can be much more efficient during the very hectic Open Enrollment period.



Contact Stateside to Discuss Tax Credits Available to You

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To Get Started

You can get the enrollment process started using any of the following:

Click on the Instant Quote link and provide census information.  Stateside will respond with a proposal that outlines your various plan options with premium cost.

Call (866) 444-3332 (toll free) and speak with a licensed representative regarding your coverage, subsidy and enrollment questions.

Email Stateside at with demographic information (date of birth, zip code and gender), and a proposal will be sent to you.

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