What Happens When the Texas Health
Insurance Pool Folds Up the Tent?
of January 1, 2014, there will be little or no need for the Texas Health
Insurance Pool due to the Affordable Care Act (ACA). Although the Insurance
Pool will continue to function, no new applications will be accepted.
Current policyholders will automatically be transitioned from the Insurance
Pool to other coverage options (although that process is not yet clear -
The Insurance Pool will no longer be
guaranteed issue coverage is mandated under ACA. Guaranteed issue means
that regardless of your health history or current conditions, you are
guaranteed to receive health insurance with no restrictions or waiting
periods related to preexisting conditions. In addition to guaranteed issue,
health insurance carriers cannot hike up your premium based on history or
Insurance Pool Policyholders Will
Experience a Significant Reduction in Premium
Individuals who are currently insured by
the Insurance Pool are paying premiums that are as much as 3 times what
policyholders are paying in the individual market. The ability to move into
one of the new in-marketplace or out-of-marketplace plans under ACA will
translate into huge savings for 2014. The savings can be increased
substantially if the applicant qualifies for the advanced tax credit offered
with in-marketplace plans. The potential to
offset the premium cost with the new federal tax subsidy is one of the
largest advantages of coverage offered in-marketplace. Depending on an
individual or family's household income, the federal government will pay a
large amount of the monthly premium. These generous premium subsidies have
not been made available for plans issued by the Insurance Pool.
Premium Subsidies Based On Income
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 2012
the FPL is $11,170 for a one-person household and rises by $3,960 for each
additional family member. Therefore, the FPL for a four-person family is
$23,050. The FPL benchmark will be adjusted for inflation each year, so
these amounts will increase in 2014.
Subsidies will be available according to
ACA rules for individuals and families with incomes ranging from 100% to
400% of the FPL. Assistance will be available for out-of-pocket expenses
(such as copays and deductibles) for those with incomes ranging from 100% to
250% of the FPL.
The math can seem confusing, and that's
where Stateside comes in. We are available to discuss your particular
situation with you, walking you through number by number.
Coverage Options Will Provide Increased
In addition to a reduction in premium
cost, plans available from the marketplaces will all include the
essential benefits, which will significantly increase the health
insurance benefits for Texas consumers. Benefits such as maternity, mental
health and substance use disorder services, preventative care and pediatric
services, including dental and vision, will now be available on policies
written in Texas, whether in marketplace or out-of-marketplace.
Contact Stateside to Discuss ACA
The Affordable Care Act open enrollment period begins October 1, 2013.
Do you understand what that means for you and your family in terms of
insurance coverage for the remainder of 2013, and into 2014? Call us anytime
to learn more.
You can contact Stateside Insurance Services in whichever way is most
convenient for you:
Toll Free: (866) 444-3332
Austin Local: (512) 542-9760
Toll Free Fax: (800) 349-2730
Run your free and instant
Texas Health Quote