What If I Missed Texas Obamacare Open Enrollment?
We get this question from Feb to December each year. Usually frantic.
Open enrollment officially ends Jan 15th barring any less common extensions. If you haven't enrolled by then, we then have to look at other options.
We'll go through those below in order of best to worst. Many people can still get coverage mid-year with Special enrollment triggers and we'll touch base on the secret one which is pretty fantastic.
First, our credentials:
This is what we'll cover:
- What if I miss Obamacare open enrollment in Texas
- What are Texas Special Enrollment Periods for Obamacare
- The 150% income special enrollment trigger
- Short term health insurance in Texas to cover gaps
- How to quote and enroll with free assistance
Let's get started.
What if I miss Obamacare open enrollment in Texas
First, let's understand that Obamacare is just short hand for any individual family plan available in Texas now whether on or off-exchange.
Same benefits. Same networks. Same Open Enrollment Rules!
So...Open Enrollment is from Nov 1st - Jan 15th each year.
This speaks to when you can ENROLL as opposed as to when the plan will actually start.
Here are the general rules:
- Enroll Nov 1 - Dec 15th for Jan 1st effective date
- Enroll Dec 16 - Jan 15th for Feb 1st effective date
We went through when you can enroll or change plans for Texas Obamacare.
We can enroll or change plans during this time with no questions asked!
One note...loss of other qualified coverage like an employer plan will allow you to get the 1st of the month following enrollment regardless of what time of the month you enroll.
So...from Jan 16th through Nov 1st, we're under a different set of rules.
The Special Enrollment Periods or SEPs.
What are Texas Special Enrollment Periods for Obamacare
Here are big ones we come across every day:
- Loss of qualified coverage (employer, medicaid, etc)
- Move to or within Texas that changes plan options
- Family make-up change: marriage, divorce, birth, death
- Change in legal status: incarceration, citizenship, etc
Those are the usual suspects with many lesser known (and common) triggers.
We even see storm SEPs pop up occasionally for certain counties.
Check with us regarding your situation at help@texasplans.com or 800-320-6269.
There's one trigger that's a pretty well kept secret.
Not with us!
The 150% income special enrollment trigger
If your income is between 100% and 150% on the chart below, we may be able to enroll outside of open enrollment.
Not only will you qualify for the richest subsidy (more on Texas obamacare subsidy) but also the silver 94 benefit increase which is much richer.
Learn about the Texas enhanced silver plans.
A few notes on the income piece.
- It's an estimate for the AGI on the 1040 tax form; next April's filing
- Household is everyone that files together on a 1040 tax form even if not enrolling
Many things can trigger this income estimate change:
- Loss of job, hours, or income
- Temporarily drop in working (helping parents, taking time off, etc)
- changes in income (meaning this or last month) that fall in the range
If your monthly income reflects this new amount or your annual, reach out to us and we'll guide you through the process.
help@texasplans.com or 800-320-6269. Zero cost for our assistance.
You may have made a lot more for the first half of the year and now it's dropped. We need to look at that together!
There are potentially $1000's in subsidies in question from a quick 5 minute conversation.
The other aspect is that we're able to enroll outside open enrollment if our income estimate is within this range.
One note...below 100% on the chart above, you get nothing unless also eligible for medicaid (usually pregnant or disabled).
Again, we're happy to help you investigate these options. Big review on the 150% income special enrollment trigger in Texas.
What if we really don't have a special enrollment trigger and want some type of protection.
Short term health insurance in Texas to cover gaps
Luckily, we still have short term health plans available in Texas.
These can start as early as midnight after enrollment any time of the year.
Worst case, we may have to get a short term plan till either Open Enrollment swings back around OR we qualify for an SEP above.
The good news is that we have UnitedHealth as a Texas short term carrier which is great since they're a solid carrier with a good network.
Pro's and Con's of Short term health if we miss open enrollment:
Pro's:
- Enroll any time of the year, eff date as early as midnight after enrollment if approved
- Unitedhealth offers full range of options and a solid Texas network
- Wide range of benefit options to keep costs down
- Can enroll up to 360 days in a block
- Actual health insurance with State oversight around paying for claims
What about con's?
- Not required to cover everything that Obamacare plans cover
- No subsidy based on income
- Need to qualify based on health and can be declined
- Waiting period for pre-existing conditions
- Does not cover a full year and needs to re-qualify
Check out our review on Texas short term health to learn more. This is our backup option in case we missed open enrollment and don't have an SEP.
Alright, so how do we quote the different options available?
How to quote and enroll with free assistance
We make this free, fast, and easy here:
Also, short term quoting is here:
For the Obamcare plans with SEPs, income is super important:
- Best estimate for this year's income; AGI on the 1040; next April's filing
- Household is everyone on a 1040 tax form together, even if not enrolling
If you get confused on the questions around SEPs, let us know as we're happy to help. Learn how to compare Texas obamacare plans or how to pick the best plan.
There's zero cost for our assistance.
Short term is pretty straight forward although you have lots of options which we go through at our Short term Texas guide.
help@texasplans.com or 800-320-6269.