Does Texas have Obamacare?
Let's clear up a few questions that come up daily and more importantly, explain how it can mean $1000's of dollars in subsidies towards your choice of health plan.
Since 2014, there's been confusion in Texas and the doctor's offices aren't helping much (more on this below).
First, our credentials:
We'll cover this:
- Does Texas have Obamacare
- How does Obamacare work in Texas
- What's the difference between Obamacare and off-exchange
- Who qualifies for Obamacare in Texas
- When can I enroll in Obamacare in Texas
- How to quote Obamacare plans
Let's get started with everything you need to take full advantage of the law.
Does Texas have Obamacare
Yes! The ACA (Affordable Care Act) law was passed in 2014. It's called by many names:
- Obamacare
- On-exchange
- ACA
They're all the same thing!
Basically, Obamacare was a set of laws that standardized how health insurance worked.
The biggest changes (among many):
- No waiting period for pre-existing conditions
- Can't be declined coverage but with special rules on when you can apply
- Subsidies based on cost to reduce cost
- Standardized plan benefits along 4 metallic levels (bronze, silver, gold, and platinum)
Those are just the highlights but really, the subsidy is the big deal now.
If you qualify based on income, it can mean a lot of money in your pocket.
Check out the Texas Obamacare income chart here.
So...how does this work in Texas since we like to do things our own way!
How does Obamacare work in Texas
Your health insurance is ultimately with the carrier of choice (BCBS of TX for example).
Texas decided to piggyback the existing Federal exchange which just administered the subsidy part of it.
For example:
- Your plan of choice with a carrier is $500
- The subsidy based on income is $350
- You get a bill from the carrier for $150/monthly!
This all settles out at tax time the following year since it's based on an estimate for this year (more on getting the most out of the subsidy).
We must enroll through the exchange (access online Texas health exchange app) in order to get the subsidy.
After that, most interaction is with the carrier directly (claims, monthly premium payments, etc).
We can help with all interactions with the Exchange and there's zero cost for our assistance!
Just email us at help@texasplans.com or 800-320-6269.
This makes interaction quite simple as opposed to dealing directly with the Federal Exchange. Just email us changes!
So...what's the difference between on-exchange and off? Are they both Obamacare?
What's the difference between Obamacare and off-exchange
This is interesting (to us, anyway).
You can get a set of plans from the different carrier on and off-exchange:
- Same basic benefits
- Same networks
- Same core pricing
The difference is that we can NOT get the subsidy off-exchange.
If we're even in the ballpark income-wise, we definitely want to enroll on-exchange for Obamacare in Texas.
That's found money!
Otherwise, there's nothing to lose since the benefits, networks, and pricing are the same.
Now, some doctors will say they don't take Obamacare.
What they mean is that they don't take individual/family plans as opposed to Medicare or employer plans which can have different networks.
The doctor networks are the same on and off exchange.
We don't see this lasting much longer as the enrollment in Texas Obamacare is exploding year to year right now (since Covid really).
The doctors will have to get on board as the numbers keep going up.
More on the Texas Obamacare networks here.
So...who qualifies?
Who qualifies for Obamacare in Texas
Outside of citizenship or legal status requirements, this mainly revolves around income.
The best way to estimate this:
- What is your best estimate for the AGI income on the 1040 tax form (next April's filing)
- Household is everyone that files together on a 1040 tax form regardless of whether they're enrolling
This gets tricky for many people so reach out to us. It's why roughly 50% of self-enrolled people don't get the full subsidy they're eligible for.
help@texasplans.com or 800-320-6269.
We even have a simplified online Texas Obamacare application which can take 5-10 minutes instead of the 45+ with the full app.
There's zero cost for our assistance and you can see our reviews above.
To check out the income chart, go here or run your quote with income info entered as it will show you your estimated subsidy.
So when can you enroll?
When can I enroll in Obamacare in Texas
There are two basic scenarios:
- Open Enrollment - Nov 1st - Jan 15th of each year; anyone can enroll
- Special Enrollment triggers during the year
The big special enrollment triggers are:
- Loss of coverage
- Household changes like marriage, divorce, birth, adoption
- Moves that affect coverage options
- Income changes or amounts that make you eligible for specific subsidies
Reach out to us if you're outside open enrollment so we can see what options we have.
When we enroll also affects our effective date so it's important to get assistance with the whole process.
No cost for our assistance!
So...if subsidies are the big deal with Texas Obamacare, how much are we talking?
How to quote Obamacare plans
We make this free, fast, and easy here:
A few notes to get the most subsidy.
Make sure to enter:
- Best estimate for this year's AGI on the 1040 tax form; next April's filing
- Enter your total household number (everyone on the 1040 tax form) even if not enrolling
Again, people have all kinds of situations with income pictures changing and moving throughout the year.
Reach out to us to nail this down since answering questions on the full app incorrectly can cost you significantly.
Not only the subsidy but also the richer versions of the Silver plans based on certain incomes.
How can we help? help@texasplans.com or 800-320-6269. Pick a time to chat here.