In years past, healthcare providers have had the freedom to create and offer insurance plans that responded to the needs of the Texas market – plans that included or excluded a variety of options for consumers. With passage of the Affordable Care Act (ACA) healthcare providers are required to include “essential benefits” in every available plan, as of January 1, 2014. 

What Does the Move to Mandated Plans Mean?

First and foremost, the addition of essential benefits will significantly increase healthcare access for Texas consumers. These benefits will now be available on policies written in Texas, whether in the marketplace or outside of the marketplace:

  • Maternity care
  • Mental health services
  • Substance use services
  • Preventative care
  • Pediatric services (including dental and vision).  

How will these Essential Benefits be added to existing plans?

For Texas consumers with policies effective BEFORE or on March 23, 2010For Texas consumers with policies effective AFTER March 23, 2010
Because you secured your policy before the Affordable Care Act was signed into law on March 23, 2010, your plan is considered a “grandfathered plan.” This means that your plan can remain the same, if your provider continues to offer it as such. The federal government will not require your plan to adopt additional “essential benefits,” thereby avoiding the premium increases related to these benefits.  (Keep in mind that your healthcare provider may change your premium or offered benefits for other reasons, so always pay attention to any notices they share.)Your plan is considered a “non-grandfathered plan,” and you have some important choices to make for 2014. Non-grandfathered plans must meet the essential benefit requirements that go into effect on January 1, 2014. Every non-grandfathered plan will transition on the plan anniversary date in 2014 to a plan that does include the essential benefit requirements. Texas consumers will be offered plans that correspond closely with their current plans or can apply for one of the plans offered in the marketplaces.

What Can Texas Consumers Do?

The first thing you should do is take a deep breath. Healthcare reform is finally here, and there is a lot of confusion about the options available. Here are four things to think about, and we hope you’ll call us to talk through them:

  1. Do you qualify for a tax credit subsidy? Depending on your income level, you may qualify for a tax credit that can be applied to your monthly premium cost. Contact Stateside to determine if you qualify for one of the subsidies offered by the government.
  2. Evaluate which of the three mandated benefit plans is to your advantage – platinum, gold, silver, or bronze.  Although all plans will have the essential benefits, the plans will vary by actuarial value, which means the amount of healthcare expenses that will need to be paid by the insured.  Texas policyholders will want to understand which plan type is best suited for their health history and current insurance needs.
  3. Do nothing and let the insurance provider move you to a mandated benefit plan  We don’t yet know how insurance carriers will transition their non-grandfathered plans to one of the mandated plans in Texas (, gold, silver, and bronze). Stateside can assist with whatever documentation is rolled out, maintaining contact with your carrier to implement the transition hassle-free.  Health insurance is too important to handle carelessly. Rely on Stateside’s experience and strong relationships with carriers to handle your coverage changes with no problems. 


Stateside Insurance Services, since 2003, has focused on providing comprehensive health insurance information, responsive customer service and expert industry knowledge for Texas consumers. Stateside has annually been recognized by health insurance carriers and the Health Insurance Marketplace as a Top Producer in Texas.

Whether the health insurance policy is for an individual, family, small business or supplemental Medicare coverage, Stateside dedicates the time, and our deep industry expertise, to ensure our clients have identified the best health insurance plan for their specific needs. 

Stateside is available to answer any general questions regarding your coverage options, can provide a subsidy determination, and even assist in creating and submitting online applications for ACA compliant plans during an Open Enrollment or throughout Special Enrollment periods. Stateside can be contacted either by phone (866) 444-3332 (toll free) or by email at Our Telephone Appointment System can be accessed through:

Phone Appointment Reservation

By using the Telephone Appointment System, clients can take advantage of scheduling a health insurance discussion when convenient for their schedule. During Open Enrollment phone appointment availability is expanded to include extended hours and weekends.