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Affordable Texas health insurance  Texas health reform   Texas Premium Subsidy

TEXAS CONSUMERS HIT IT BIG WITH THE PREMIUM SUBSIDY

 

The government may help pay your monthly healthcare premium?

 

Millions of Texas consumers who qualify will be eligible for premium assistance as part of the Affordable Care Act (ACA). Individuals and families who meet defined income requirements will be able to receive premium subsidies and financial assistance for out-of-pocket expenses. 

 

So pay attention, in case you fall into one of those categories!


The goal of the subsidies is to help consumers who cannot access affordable coverage either from employers or from the private insurance market by having the federal government pick up some of the tab.

 

A premium subsidy program was created to increase the number of individuals covered, especially those for whom health insurance was previously too expensive.

 

Your Family Income Determines How Much Assistance Is Available

 

In order to be eligible for the subsidies, an individual's 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 the number of family members.

 

For example, the 2019 FPL is $12,140 for a one-person household and rises by $4,320 for each additional family member. Therefore, the FPL for a four-person family would start at $25,100. The FPL benchmark will be adjusted for inflation each year, so we will see these amounts increase.


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 marketplaces. Contact Stateside so that we can do the math together.

 

We'll determine where you and your family fall in relation to the federal poverty level, and whether you qualify for subsidies.

 

Subsidy Only Available For Plans Offered Within The Marketplaces

 

Health insurance plans offered in the Health Insurance Marketplace will consist of three levels of coverage designated as 'metallic plans' for their names 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%.

 

Silver plan premiums are used to establish the level at which subsidies will be available. 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 individuals 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.

 

Call us so that we can determine what your percentages may be.

 

Where Does Your Current Income Fall?

 

The following is the FPL calculated by the number of family members and a list of FPL percentages with the corresponding percentage of income that the policyholder must pay for health insurance premium. 

 

Persons In Family Texas FPL (100%)
1 $12,140
2 $16,460
3 $20,780
4 $25,100
5 $29,420
Each Additional Person Add $4,320


 

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

 

If you'd like to know more, keep reading.

 

We realize how confusing this information may feel, and we encourage you to call us to talk through the specifics that matter to you.

 

What The Subsidy Actually Means In Dollars & Cents

 

Let's illustrate the premium cost for a family of three...


Assume a family of three has a total income of $38,180. The FPL for a family of three is $19,090. Their income is twice that amount, which places them at them at 200% of the FPL. Therefore, the family would be required to pay 6.3% of their income or $2,405 towards the premium cost of their plan.

 

The family can purchase any plan available from the marketplace, excluding the bronze plan. Using the silver plan premium of $12,000 as the benchmark, the premium paid by the family would be $2,405 - for the year - and the remaining $9,595 would be covered by the government as a subsidy. 

 

In addition to assistance with premiums, financial support for out-of-pocket expenses such as copays and deductibles are available to individuals and families whose incomes do not exceed 250% of the FPL.

 

In order to qualify for financial support, the individual or family will be required to purchase at least a silver plan within the marketplace. The amount paid by the insured for out-of-pocket expenses is based on a scale from 6% of out-of-pocket expenses for the lowest income levels up to 27% of out-of-pocket expenses for income levels up to 250% of the FPL.

 

How Much Will The Subsidy Save You?

 

The Congressional Budget Office estimates that a combination of the two benefits - premium subsidy and out-of-pocket expense assistance - will result in an average subsidy of $5,000 a year for individuals and families participating. Benefits will be much higher for families with lower incomes or several children.

 

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

 

 

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