How Much Does Health Insurance Cost in Texas for a Larger Family of 4, 5, or 6
Let's say you're not the single young person anymore and most choices these days revolve around many bodies (travel, eating, etc!).
Health insurance is no different and there are certain benefits to having a bigger family (finally) when it comes to Texas health insurance.
We'll explain below but first, our credentials:
Let's touch base on these topics:
- Quick intro to Texas health insurance for larger families of 4, 5, 6 and more!
- Why the subsidy is a larger family's best friend
- How to compare the plans for larger Texas families
- Quoting and enrolling in Texas health insurance for larger families
Let's get started. You probably only have 5 minutes break as it is!
Quick intro to Texas health insurance for larger families of 4, 5, 6 and more!
First, understand that on and off-exchange plans are both the same thing since 2014.
Same:
- Benefits
- Networks (doctors and hospitals you can see)
- Rates
These are all collectively called ACA (Affordable Care Act) or "Obamacare" since the same rules apply to both sets of plans.
By law, they have to be the same. The big difference and why roughly 99% of our enrollment is "on" exchange comes down to subsidies which we'll cover in the next section.
So, key points regarding family health plans in Texas now:
- You can't be declined based on health
- There's no waiting period for pre-existing conditions
- There are 4 basic levels from Bronze to Platinum with increasing benefits (more below)
- We need to enroll during open enrollment (Nov 1st - Jan 15th) or with special triggers (see when can I enroll in Texas obamacare).
- You can cancel month to month and coverage always starts on the 1st of a month following enrollment
Those are the broad strokes and we're happy to help you with any questions at zero cost to you but let's really jump into the big deal these days (especially for larger families).
Why the subsidy is a larger family's best friend
The biggest deal since 2014 revolves around subsidies or tax credits that the government will pay towards your choice of plan.
The subsidies are based on two things:
- Income estimate for this year's income; AGI on the 1040 tax form for this year; next April's filing
- Household is defined as everyone that will file together on a 1040 tax form even if not enrolling
Did you catch that last piece?
This means that as our family gets bigger, we qualify for more subsidy for each family member!
Hello larger family!
Many people make mistakes along this line when self-enrolling by not getting the household right or making mistakes on the income.
Don't do this alone! There's zero cost for our assistance and we spend most of our day fine-tuning the income piece since it can mean $1000's in missed subsidy (found money).
This is especially true for larger families in Texas!
We can also avoid the Medicaid or no subsidy income trap with correct income.
help@texasplans.com or 800-320-6269. It's a free service!
More on how to get the most out of the subsidy but let's look at the chart to explain the benefit of having a larger family in Texas.
If we look at the chart, you can see a roughly $7000-$8000 jump with every family member at each level.
A single person cap for the silver 87 (more below) is just under $30K. A family of four is double that at $60K!
That means if our income is under that number, we can get a subsidy and a super rich version of the silver plan.
A few notes on the subsidy:
- It's on a sliding scale as we go up with no hard cap (for now)
- Below the 100% level, you get no subsidy and only medicaid IF you qualify based on other requirements
Then there's the plan selection.
Let's go there now.
How to compare the plans for larger Texas families
This gets tricky since you can have very different healthcare needs by family member with larger families.
Sometimes, there's one person with a very serious issue.
A few notes to help guide you:
If you're eligible for the silver 87 or 94, those are hard to beat. They're basically platinum level plans for the same price of the normal silver.
You can see the income ranges in the chart above.
Otherwise, there's a real incentive for going down the scale with larger families. Bronze or silver plans.
The way to look at this is to compare the annual premium savings VERSUS the deductible level.
Why?
You'll notice from the benchmark plans below that the out-of-pocket max is roughly the same for the bronze, silver, and gold plan!
The big difference is addition of office and RX copays (Bronze to Silver) and removing the deductible (Silver to Gold).
This gets complicated but we're happy to walk through your situation.
help@texasplans.com or 800-320-6269.
You can even mix and match plans meaning, maybe a richer plan for a family member with bigger issues.
One note...the core benefits are usually up to 2 people in a family.
Meaning, if two members meet their deductible, the rest of the family may not need to. Same with the out-of-pocket max.
This protects larger Texas families with real bad years across multiple family members.
More on how to compare the Texas metallic plans.
This is all great general info but let's look at actual numbers please.
Quoting and enrolling in Texas health insurance for larger families
We make this fast and easy for larger Texas families here:
Make sure to enter the right income info:
- Best estimate for this year's income; AGI on next April's 1040 tax form
- Household size is everyone that files on that 1040 tax form
We're happy to run these numbers for you with zip code, dates of birth, and best estimate of this year's income.
help@texasplans.com and we'll get started.
We can enroll during open enrollment with special enrollment triggers.
The most common being:
- Loss of other coverage
- Move to/within Texas that affects our options
- Change in family make-up: marriage, divorce, birth, death, etc
- Change in eligibility
- Income below 150% on the above chart
Reach out with your situation as there are less common triggers!