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Affordable Texas health insurance  Texas Health Reform Center Texas health exchange

 

2019 TEXAS HEALTH INSURANCE EXCHANGE OVERVIEW

 

Effective January 1, 2014 health insurance exchanges began 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 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 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 Texas exchange provides three 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 bronze, silver and gold. Bronze plans will have an actuarial value of 60%, silver will have an actuarial value of 70% and gold will have an actuarial value of 80%. 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.

 

Open Enrollment is scheduled for November 1 to December 15 and applications submitted during this period will be assigned a January 1 effective date. After the close of Open Enrollment on December 15, an application can only be submitted if the individual qualifies for a Special Enrollment Period or SEP.

 

The SEP duration is 60 days following the triggering of one of the following nine life events.

 

  • Loss of Essential Health Coverage - includes loss of employer coverage or loss of Medicaid or CHIP as a result of a reported change in household income or other circumstances.
  • Change In Family Size - marriage, divorce, death of a family member, birth, or adoption.
  • Change In Citizenship - gaining status as a citizen or a lawfully present individual in the U.S.
  • Enrollment Error - experienced an error in your original enrollment.
  • Violation of Plan Benefits - an individual who enrolled in a qualified health plan and is able to demonstrate that the plan substantially violated a material provision of the plan.
  • Change In Premium Subsidy Eligibility - becoming newly eligible or newly ineligible for the premium subsidy or cost sharing reductions.
  • Relocation - new plans become available based on moving to a new area.
  • Indian - the individual is an Indian, as defined by the Indian Health Care Improvement Act.
  • Exceptional Circumstances - a qualified enrollee is subject to other exceptional circumstances as determined by the Exchange.

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 $12,140 to $48,560
Family of 2 $16,460 to $65,840
Family of 3 $20,780 to $83,120
Family of 4 $25,100 to $100,400

 

 

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

 

Again, there is absolutely no cost to you for our services. 

 

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.

 

 

You can also contact Stateside Insurance Services in whichever way is most convenient for you:


www.texasplans.com 
Toll Free: (866) 444-3332
Austin Local: (512) 542-9760
Email: info@texasplans.com
Toll Free Fax: (800) 349-2730

 

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

 

Again, there is absolutely no cost to you for our services.  Call 866-444-3332 Today!

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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: $12k - $48k
2 People $16k - $65k
3 People $21k - $83k
4 People $25k - $100k

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