For the second year in a row, Texas has the highest number of people without insurance. The U.S. Census Bureau reports that 2018’s figure of five million people with no health coverage is double the national average, sitting at 17.7%. It’s also one of the 14 states in the U.S. that haven’t expanded Medicaid.

This means it’s more important than ever to understand the options open to you when looking for health insurance in Texas. The process of finding affordable health care plans in the healthcare marketplace and enrolling in plans at the right time can save you on steep medical costs later on.

What Are Your Health Insurance Plans In Texas?

The new limitations on health insurance mean Texans have to be more organized when considering their options. Your first step is to understand whether to choose ACA-compliant health plans, non-ACA plans, or short term health insurance in Texas.

ACA-Compliant Health Insurance Plans

Accessing ACA-Compliant health insurance plans through Texas health markets is the most popular and convenient option for consumers. However, you will still have your work cut out for you. Your search is bound to be a negotiation between the cost of coverage and your personal medical requirements.

To keep things simple, there are three tiers of coverage under ACA-Compliant health insurance plans. These include:

Bronze
Bronze

What it covers: Bronze plans feature cost-effective monthly premiums. However, high out-of-pocket costs offset these low payments. The deductibles and out-of-pocket maximums are near or at the highest amount allowed by law. For example, in 2020, this would be $8,100 for an individual and $16,200 for a household.

Who it’s for: The lower premiums are appealing, but the high out-of-pocket costs make it very clear – Bronze and catastrophic plans are intended for youth and individuals who are generally in good health. They rarely, if ever, have to visit the emergency rooms, and they experience no chronic or ongoing health issues. Bronze health insurance coverage works best in cases of emergencies. If you had to rack up a sudden, large bill because of a serious accident, this would cost tens of thousands of dollars. A Bronze plan would kick in and really give you your money’s worth in this case.

Silver
Silver

What it covers: Most individuals go for Silver plans because they are the most affordable options for health care in Texas. However, these middle-of-the-way plans are also the ones that experience the most substantial changes to premiums. By contrast, Bronze and catastrophic plans in Texas experienced a rate decrease over two years. These plans are the only ones in the metal line-up that come with a cost-sharing reduction variation. This allows households to take advantage of lower copays, deductibles, and coinsurance.

Who it’s for: Silver plans work well for low-income to average-income households and individuals. Households with an income that is less than 250% of the federal poverty level can use a Silver plan to get the most out of their insurance.

Gold
Gold

What it covers: Gold plans have much lower copays, coinsurance, and deductibles when compared to standard plans. The monthly premiums are higher overall, but these are hard-working plans if the individuals opting for it truly need and use medical services on a routine basis.

Who it’s for: The out-of-pocket expenses you’ll pay for on a Gold plan are significantly lower, if not entirely negligible. If you’re someone who frequently requires prescription medication, this is a significant benefit. Prescription medication is typically the area of any plan with the highest routine use. Consumers who expect that they will require frequent access to medical care and expensive procedures will benefit most from the Gold plan.

In Texas, your age directly impacts the premiums you will pay for health insurance, and you can use this to your advantage to move between tiers of coverage.

Understanding Your Texas Health Insurance Coverage

Health insurance is your safety net against hefty medical expenses. It covers specific medical services outlined in your plan and determines how much you and your insurer will contribute. You pay a premium either monthly or annually for this coverage.

Once you’ve purchased a policy, your insurer guarantees coverage for your healthcare expenses related to covered conditions. However, you may still need to pay some costs out-of-pocket to utilize your health insurance. But don’t worry, there’s a cap on how much you’ll need to pay.

  • Deductible: This is the amount you must pay each year before your insurer covers your expenses.
  • Copays: These are small fees you pay for a medical service.
  • Coinsurance: Once you’ve paid your deductible, you’ll pay a percentage of your medical bills.
  • Out-Of-Pocket Maximum: This is the maximum amount you’ll need to pay each year for deductibles, coinsurance, and copays. After reaching this limit, your insurer takes over according to your plan.

Health insurance plans for every stage of life

Health insurance plans cater to individuals at every stage of life, ensuring comprehensive coverage tailored to their specific needs.

  • Dental insurance plans offer relatively low monthly premiums and can cover a range of dental services, from routine cleanings to more extensive procedures.
  • Vision insurance plans cover annual eye exams and may help reduce the cost of contact lenses or glasses.
  • Short-term insurance plans are designed to temporarily provide limited health coverage for unforeseen needs, offering affordable options and easy enrollment.
  • Medicare insurance plans including Part A and Part B, provide coverage for hospital expenses, outpatient care, and prescription medications, offering comprehensive healthcare solutions for those eligible. Whether you’re in need of dental, vision, short-term, or Medicare insurance, there’s a plan to suit your requirements at every stage of life.
Short Term Health Insurance

Short-term Health Plans – Non-ACA Plans

ACA-Compliant plans have certain requirements they must meet to qualify as such. These are known as “Minimum Essential Coverage” or MEC, and the list includes 10 services the ACA thinks are absolutely essential to healthcare in Texas. Coverage for pre-existing conditions is also a standard part of ACA plans.

Short-term plans are temporary solutions for those who wish to save money on medical care. These plans offer temporary medical coverage and are often used as a kind of bridge to medical care access before the individual shifts to a different health plan.

While short term health insurance in Texas calls for a lower up-front cost, these plans also offer less coverage in kind. Keep in mind, as well, that health marketplaces don’t offer short term health insurance in Texas.

Individuals currently using short-term health insurance can have plans with an initial term of up to 12 months (364 days). However, with new federal rules effective September 1, 2024, this will change. Under the new regulations, short-term health plans will be limited to a total duration of no more than four months, including any renewals. The initial term of these plans will be capped at three months.

Frequently asked questions

  • How do you get health insurance in Texas?

    To get health insurance in Texas, you can explore options through your employer, brokers, or the Health Insurance Marketplace. You may also qualify for government programs like Medicaid or CHIP based on your income and other eligibility criteria.

  • What is the best health insurance in Texas?

  • How much does health insurance cost per month in Texas?

  • Does Texas require you to have health insurance?

  • What’s the cheapest health insurance in Texas?

  • What type of health insurance marketplace does Texas utilize?

  • When can I enroll in an ACA-compliant plan in Texas?

  • How can I save money on health insurance in Texas?

  • Can I get free Texas health insurance?

  • Can I have short-term health insurance in Texas?

  • What is the difference between HMO and PPO health insurance plans in Texas?

How To Purchase Best Health Insurance In Texas

From November 1st to December 15th, individuals and families can pick their insurance providers and plans. This is the process of open enrollment, and it encourages consumers to re-assess their health needs each year. There are also instances when you can enroll outside of this time period. We offer a wide selection of private health insurance plans in Texas for individuals and families.

At AHiX Marketplace, we simplify the process of applying for best health insurance in Texas. Both ACA-compliant and non-ACA plans are accessible through our convenient marketplace technology. Gain direct access to carrier feeds for pricing, enrollment, and service. Chat with one of our live care specialists or visit AHix Marketplace to learn more about our easy enrollment process for affordable health insurance in Texas.