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Affordable Texas health insurance  Texas health reform   Texas Insurance Pool after 2014

What Happens When the Texas Health Insurance Pool Folds Up the Tent?

As 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 - stay tuned). 

The Insurance Pool will no longer be needed because 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 medical condition.

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 Benefits

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 Updates
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
Email: info@texasplans.com
Toll Free Fax: (800) 349-2730

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