Health Insurance for Low Income Texans

 

There are a lot of questions around what options are available if we have lower income as an adult.

There's good and bad news there. We'll cover both below.

Texas has a clear line in terms of what is "low income" which means a huge difference when it comes to health insurance and its cost.

First, our credentials:

This is what we'll cover:

• What health insurance is available to low income Texans
• The tricky part about Medicaid
• Getting the full subsidies and richer silver plans from the Exchange with low income
• How is the income estimate calculated
• The 150% income trigger that allows us to enroll year-round
• How to quote and enroll in Exchange plans with low income

 

Let's get started!

What health insurance is available to low income Texans

 

We'll get into what qualifies as low income but really, Texans have two different potential options:

• Medicaid - if our income is under 100% of the FPL and we meet other requirements
• Exchange subsidies - with income over 100% of the FPL

 

These are very different options with one being State-sponsored (Medicaid) while the other one has the full networks and subsidies to bring down the cost.

Before we get into differences, let's look at the income:

You can see the 100% levels by size of household.

One note...household is everyone that files together on a 1040 tax form for the year in question.

It doesn't matter if you have someone living in your house... if you don't claim them on your taxes or file together, they're generally not part of the household.

The tricky part about Medicaid

 

Texas did not decide to expand Medicaid under the ACA law as some States did.

So we have to have income below a certain limit AND usually one of the following:

• Be disabled as an adult
• Be pregnant
• Have a dependent child who has Medicaid

You can check with Medicaid directly for less common triggers, but it's generally pretty tough to qualify!

Here's the official verbiage:

• Children aged 0-1: 198% of the federal poverty level (FPL)
• Children aged 1-5: 144% of FPL
• Children age 6-18: 133% of FPL
• Pregnant women: 198% of FPL
• Adults caregivers of children or adult relatives: 14% of FPL
• Children are eligible for either Medicaid or CHIP if their household incomes are up to 201% of poverty

Texas has not expanded Medicaid under the ACA, so adults under 65 who aren't disabled or raising a child are ineligible for Medicaid regardless of how low their income is.

Read that last bit. Basically, if you're an adult and not disabled or raising a child, Medicaid is not an option.

What if our income is under the 100% level on the chart above then?

Not only do we not get Medicaid, but we also don't qualify for a subsidy on the Exchange!!

Now, if our income estimate is right above the 100% level, we get massive subsidies and very rich versions of the silver plan.

One note on Medicaid: The system can recoup losses when you pass away to pay back past medical costs. Most people aren't aware of this "claw back."

Getting the full subsidies and richer silver plans from the Exchange with low income

 

You can easily run your free quote here to see what you qualify for based on income:

 

With income up to roughly 250%, we can see pretty large subsidies, which come right off your monthly premium you pay to the carrier.

 

 

For older people, the income can go quite a bit higher and still show a subsidy!

On the chart above, you'll see the ranges for the silver 94, 87, and 73.

This means the silver plan level can be much richer than the standard silver for the same price with the 94 and 87 being really rich!

 

 

The quote system above will automatically show you these plans if you're eligible.

So...income really matters quite a bit. Let's dive into that practically.

How is the income estimate calculated

 

We spend half our days on this piece now.

Trying to fine-tune the income estimate is complicated for most people, especially self-employed or people whose income is in flux.

It's nearly impossible for a large percentage of the population to estimate their full year's income out a year in advance.

That's what we're trying to do!

For example...if we're enrolling for 2025, we're trying to estimate the AGI on our 1040 tax form when we file April 2026.

Good luck with that if you're self-employed.

So...what if we estimate at $15K (above the 100% limit) but we finally get our taxes done, and it's under the 100% limit?

Technically, there was a $300 penalty written into the ACA law, but they have never applied it since they realized it's impossible for many  people to accurately estimate a full year out, and the penalty would hit the very people that the law was intended to help.

So, you don't pay back the subsidy or the richer silver benefits.

They are more concerned with people under-reporting income to get more tax credit than over-reporting if they generally don't know.

Of course, we want to update income estimates if things change during the year, but now you understand what happens if our estimate is higher than what our actual comes in at the following tax time.

Reach out to us with our specific situation, and we can walk through it with you since everyone's situation is different.

We've seen it all.

Roughly 50% of people who self-enroll have issues around this income piece, which causes them to miss out on subsidies!

The 150% income trigger that allows us to enroll year-round

 

There are different triggers (called SEPs) to enroll outside of open enrollment, but one of them is tied to income.

If our income is between the 100%-150% on the above chart, we can enroll anytime during the year!

That's a special enrollment period! We can help you navigate this whole process.

We have a whole review on this 150% income SEP in Texas, but we'll guide you through the process and there's zero cost for our assistance!

Okay...so what are we looking at monthly?

Sometimes zero! Let's go there now.

How to quote and enroll in Exchange plans with low income

 

You can run your instant quote with subsidies automatically calculated here:

 

Make sure to enter your annual income estimate.

• Household is everyone that files together on a 1040 tax form; April the following year.
• Income is the AGI on the 1040 tax form for that household

 

Things get complicated quickly, so reach out to us if you need help or don't want to mess it up.

It is potentially $1000's per year!

There's no cost for our assistance.

Zero cost for our assistance: