Texas Health Insurance Marketplace
In Texas, the federal government operates the health insurance Marketplace.
Texas now has its own Marketplace for health insurance, where you can shop for and buy insurance in person, online, or by phone.
Texas Plans, Benefits, and Costs
Last year average total cost for Health Insurance for a 40 Year Old Non-Smoker in your state was $0 per month after tax subsidies. See if you qualify for a free or low cost plan.
Companies can offer four types of plans: bronze, silver, gold, and platinum. These “metal level” plans all cover the same benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers.
Tobacco Surcharge: Texas allows insurance companies to charge tobacco users 50% more than non-tobacco users.
Who Is Selling Insurance in the Texas Marketplace?
On exchange plans in Texas
- Blue Cross Blue Shield of Texas
- Celtic Insurance Company (Ambetter)
- CHRISTUS Health Plan
- Community Health Choice, Inc.
- Humana Health Plan of Texas, Inc.
- Molina Healthcare of Texas
- Oscar Insurance Company of Texas
- Prominence HealthFirst of Texas, Inc.
- Sendero Health Plans, inc.
- SHA, LLC DBA FirstCare Health Plans
Off exchange plans in Texas
- All Savers Insurance Company (UnitedHealthcare)
- Blue Cross Blue Shield of Texas
- Cigna Health and Life Insurance Company
- Humana Insurance Company
All approved plans in the state must cover the same package of benefits, called essential health benefits. In Texas, the benefits include:
- Outpatient services, such as doctor visits or tests done outside a hospital
- Emergency services
- Hospital stays
- Pregnancy and baby care
- Mental health and substance abuse services, including behavioral health treatment
- Prescription drugs, including generic and certain brand-name drugs
- Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with developmental issues. In Texas, habilitative services, including physical, occupational, and speech therapy, are covered for children with autism up to age 10.
- Lab tests
- Preventive and wellness services, along with those that help people manage chronic conditions. This includes chiropractic care.
- Services for children, including dental and eye care.
Some services not included: weight loss surgery, weight loss programs, long-term care, acupuncture, and cosmetic surgery.
Will These Benefits Be in All Plans?
Although all health insurance policies have to include these benefits, some states may allow insurance companies to substitute a service that has the same value. For example, one type of lab test may be substituted for another. Make sure to read the summary of benefits of the plans you are considering to see if they include the coverage you need.
You may be eligible for financial aid to help pay for insurance. Here’s what Texas will offer:
Medicaid Expansion: Some states are expanding Medicaid so more people can get health insurance coverage. Although Texas is not, you may still qualify for some type of assistance.
Premium Subsidies (also known as Tax Credits ): You may qualify for a federal subsidy to help lower your monthly premium. The subsidy is available only if you buy your insurance in the Marketplace. In general, you’ll be eligible if you’re single and make between $11,770 and $47,080 a year, or if you have a family of four and make between $24,250 and $97,000 a year. Subsidies are based on your estimated household income for 2016 and the cost of the health plans in your area. The lower your income, the more assistance you will receive. You can use your 2015 tax return to estimate your 2016 income. When you file taxes for 2016, the IRS will adjust your subsidy based on your actual income.
Cost-sharing subsidies: Depending on your income, you may also qualify for cost-sharing subsidies that will reduce your costs when you receive medical care. Cost-sharing subsidies are available only with silver-level plans.
CHIP: The Children’s Health Insurance Program provides coverage for children of some families who have a low income but are not eligible for Medicaid.