When Can I Change Texas Obamacare Plans?
This is one of the more confusing aspects of the Texas individual and Family market now.
Since 2014, coverage has been guaranteed issue which means you can't be declined based on health.
To offset this, certain requirements were put into effect around when you're able to enroll!
Let's walk through both the more common situations a few aces we have up our sleeves.
Keep in mind that these rules apply to both on-exchange or off-exchange! All governed by the same ACA law.
First, our credentials:
This is what we'll cover:
- Open enrollment for Texas Obamacare
- Common special enrollment triggers
- The income trigger for enrollment
- Year round medicaid
- How do effective dates work
- Short term coverage till Open Enrollment
- How to quote and enroll in Texas Obamacare
Let's get started.
Open enrollment for Texas Obamacare
This is the big one most people know about.
At the end of each year, we're able to enroll in Texas Obamacare from Nov 1st - Jan 15th.
In order to get a Jan 1st effective date of the following year, we'll need to enroll by Dec 15th in most cases.
We can make as many changes as we need up to that point and still get the Jan 1st effective date.
There's always a mad hustle to calculate income and find the right plan for the following year so reach out to us.
We're trying to estimate our income for the following year.
Meaning... if it's Nov 1st of 2024, we're trying to estimate our AGI on the 1040 tax form of April 2026.
This can be tough for people. especially self-employed or people with variable income.
Email us at help@texasplans.com or call 800-320-6269. Book a time to chat here.
This is the easiest of the times to change coverage and we can move both carriers and plans up or down.
After 12/15, the eff date will push out to 2/1 or even 3/1 depending on when the app is submitted. Let us know what you need and we'll help guide you at zero cost to you.
Okay. so we missed open enrollment. What can we do?
Common special enrollment triggers
First, let's hit the big ones we see all day long (think big life changes):
- Loss of coverage
- Family make-up changes: marriage, divorce, birth, death
- Moves to/within Texas that affects plan options
- Changes in legal status (becoming citizen, etc)
- Member of Federally recognized Indian Tribe
- Error when enrolling from person in official capacity
- Income estimate at or under 150% of the Federal limit
A few notes before we jump into the last one there.
Loss of coverage will allow you to get the 1st of the month following enrollment regardless of when you process the app (access Texas Exchange app here).
The others generally require app submittal by the 15th of the month to get the next 1st. Otherwise it will push you out to the 1st of the following month!
More on this below but just know that loss of coverage is the most flexible.
Most of these require some kind of big change. Let's look at that income one.
The income trigger for enrollment
This is our favorite because we can use anytime of the year and most people don't even know they qualify.
Better yet, they're also eligible for huge subsidies and very rich versions of the Silver plan.
First, the income chart for the Texas Exchange:
So, based on your household size, if your income is at or below 150%, we may be able to enroll anytime!
This is a very special trigger. Income estimates changes all the time as our employment changes all the time.
It's an estimate for the full year (next year's AGI on the 1040 tax form) so reach out to us if this might be an option.
We'll fine tune the income calculation since it's confusing for many people.
More info on the Texas Obamacare income chart. This definitely gives us some flexibility.
Year round medicaid
If you're eligible for medicaid, you can enroll year-around.
Check with your local county to verify if you can qualify since it's both an income basis and other requirements (usually pregnant or mentally disabled).
Medicaid does not have the same enrollment periods as the Texas Exchange.
Okay. back to Obamacare. Let's zero in on those effective dates.
How do effective dates work
There are basically three different situations:
- Enroll from Nov 1st - Dec 15th; get Jan 1st effective date
- Enroll from 1st - 15th of a month; get next 1st of the month
- Enroll from 16 - end of month, get the following 1st of the month (1 month from the next 1st)
Losing other coverage whether employer based, Cobra, medicaid, or from moving allows you to get the next 1st of the month regardless. It's the most flexible.
If you have a special situation, reach out to us at help@texasplans.com or 800-320-6269 and we can dial that in.
What if we've missed open enrollment and we don't have any special enrollment triggers (check with us as there are some weird ones that pop up)?
Texas short term plans to get to open enrollment
Worst case, we can get a short term health plan up to 360 days to get us out to open enrollment.
We're lucky to have this in Texas as other States have banned it. It's a great tool between coverage.
Learn all about Texas short term health plans and you can quote those here:
So. we want to get started. Now what?
How to quote and enroll in Texas Obamacare
You can quote the Texas obamacare plans here:
A few notes.
To get the best quote, make sure to enter the following:
- Household is everyone that files together on a 1040 tax form
- Income is your best estimate for this year (next April's AGI on the 1040 tax form)
Learn how to compare the Obamacare plans or how to pick the best plan.
These can get tricky fast so reach out to us and we'll make sure you get the best subsidy available. Learn more on how to get the most subsidy.
You can always enroll in Texas Obamacare plans right away here.
We're happy to help with any questions!