Obamacare, officially known as the Affordable Care Act (ACA), was signed into effect nationwide in 2010 and the enforcement of its regulations started in 2014. The purpose of Obamacare was to increase U.S. citizen access to healthcare through expanding Medicaid programs, protecting consumers from being discriminated against due to pre-existing health conditions, opening a regulated Marketplace to shop for cost-efficient public health insurance options, and requiring all U.S. citizens to have a qualified health plan.
Obamacare’s Effect on Texas Health Insurance
In Texas, Obamacare has resulted in a dramatic decrease of uninsured residents. In 2010, when Obamacare was signed, the United States Census Bureau’s Current Population Survey rated Texas as having one of the highest rates of uninsured people, with 24.6% uninsured residents; that’s 6.2 million uninsured Texans. In 2015, the uninsured rate in Texas is still the highest in the nation, yet has drastically dropped to 16.8% (an almost 32% drop) since the introduction of Obamacare in Texas. The National Health Interview Survey has determined the uninsured national average to be 9.1%.
What Texas Residents Should Know About Texas Obamacare
Pros and Cons of Texas Obamacare
Texas Obamacare has made health insurance coverage available to millions of Texans that could not previously afford care. It has been successful in helping individuals take more responsibility for their personal care by allowing for more insurance-covered wellness programs and early health screenings. Finally, Obamacare in Texas has eliminated health insurance companies' ability to deny healthcare coverage to individuals based on pre-existing conditions and has disabled companies from being able to charge a higher premium to individuals based on race or gender.
Critics of Obamacare in Texas claim that while access to health insurance coverage has increased, the Texas middle class has actually suffered higher medical costs due to the increase in plans deductibles. In addition, there has been a notable struggle in getting Obamacare plan re-enrollments, especially for the healthy young adult population who would rather pay the penalty for not having coverage than be responsible for monthly health insurance premiums they cannot afford.
Apply for Obamacare: Health Plans and How Much You Will Pay
When shopping in the Texas Obamacare Marketplace, you will find four primary health plans to can choose from: Bronze, Silver, Gold, and Platinum. These plans each have a different percentage of healthcare costs they will pay for over the course of a coverage year; the remaining percentage (out of 100%) is what you will be expected to pay. For example, if you choose the Bronze Plan because its monthly premiums are lower than the others, you can expect that your insurance will pay for 60% of your healthcare costs and you will be responsible for paying the remaining 40%. While this level of Obamacare plan will cost you less than the others in monthly premium costs, it unfortunately also leaves you financially responsible for paying a higher amount of the overall healthcare cost itself compared to any of the other plans which pay at least 70% or more of healthcare costs.
Here are the different Obamacare plans and the average percentage of your healthcare cost they will cover:
- Bronze Plan – 60%
- Silver Plan – 70%
- Gold Plan – 80%
- Platinum Plan – 90%
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How do I sign up for Obamacare in Texas?
You can get Texas Obamacare quotes and sign up for Obamacare plans through the Texas Obamacare Marketplace. This Marketplace can be accessed through the federal website, healthcare.gov, or by calling (800) 318-2596.
What is the Obamacare Marketplace?
In the case of Obamacare, Texas utilizes a Federally-Facilitated Marketplace (FFM), which means that the U.S. Department of Health and Human Services operates and manages the Marketplace where public health insurance plans are offered. The Marketplace is a central location to shop for different TX Obama care insurance options and it is also where you can enroll in a TX Obamacare insurance plan.
Do I have to use the Marketplace?
To enroll in an Obamacare health insurance plan, you will need to go through the federal Marketplace. The only exception to using the exchange to sign up for Texas Obamacare is if you are able to seek help from a Texas certified counselor or a private insurance agent who can discuss your options and select a plan through the exchange, on your behalf.
How do I use the Obamacare exchange in Texas?
You can use the exchange in one of four ways:
- Visit healthcare.gov
- Use the telephone support assistance available by calling (800) 318-2596
- Find a local certified counselor
- Seek help from a private insurance agent
What does it mean to be on-exchange or off-exchange?
On-exchange generally refers to purchasing public health insurance from the Obamacare Texas Marketplace while off-exchange refers to purchasing private health insurance coverage from a private company or marketplace.
When is the Obamacare enrollment deadline and what do I do if I missed it?
The Obamacare open enrollment period for 2017 in Texas is from November 1, 2016 until January 31, 2017. If you miss enrollment, you would need to qualify for a special enrollment period due to a qualifying life event or purchase short term individual private insurance to avoid a health insurance penalty.
What is the Obamacare penalty if I don’t buy health insurance?
If you do not enroll in Obamacare or another qualifying health plan (also referred to as “minimum essential coverage”) you will be subject to a tax penalty for each month you go without coverage. This fee should be paid when you file your federal tax return. In some special cases, there are exemptions to this penalty.
The Obamacare penalty for 2016 is either 1) 2.5% of your household income, with a maximum of the price of a Bronze plan sold through the Marketplace, or 2) $695 per adult and $347.50 per child under 18 years of age with a maximum of $2,085. You will pay whichever of the two options is higher.
The Obamacare penalty for 2017 is fairly similar to 2016 with the percentage fee of 2.5% remaining the same, however, the flat fee will be adjusted for inflation.
What if I cannot afford Obamacare?
If you cannot afford to pay for an Obamacare plan, you may be able to qualify for a government subsidy. For more information on government subsidies, visit the HealthCare.gov website.
What are the alternatives to Obamacare Insurance in Texas?
Any health insurance coverage that meets the requirements of a qualified healthcare plan, as set forth in the Affordable Care Act, can be used. This is the case whether coverage is received through an employer, private insurance company, or purchased through a private exchange.
There are several alternatives available when selecting health insurance coverage. You can select one of the available alternatives on the Marketplace, one of the many options available on the private exchange, or see if you are eligible for subsidized programs through the Texas Medicaid program.
Obamacare Health Insurance FAQs
How Much Does Obamacare Cost in Texas?
This is dependent on your income level, the type of coverage selected, age, and if you smoke.
Is there a way to decrease my Obamacare cost?
Your cost is impacted by the level of coverage that you select. See above Obamacare plan breakdowns for the percentage of healthcare costs that each plan covers.
What if I can’t afford Obamacare? Is there Cost assistance?
Yes. If you are unable to pay for the cost of Obamacare coverage, you may find that you qualify for government subsidies. Subsidies depend on income and the number of family members in the household.
Does Texas Obamacare cover pre-existing conditions like maternity, IVF, diseases or illnesses?
Yes, under the Affordable Care Act, it is illegal for health insurance companies to deny coverage due to pre-existing conditions or maternity.
Do I need to buy additional or supplemental insurance on Obamacare?
This depends on the level of desired coverage. You may want to pursue supplemental insurance for specific health scenarios.
Obamacare Health Insurance Plans vs COBRA
COBRA allows you to continue to utilize your previous employer's insurance plan regardless of your employment status for a designated period of time by paying the entire premium. This is generally not cost effective and a similar option can be purchased at a smaller dollar amount via the Federal Exchange.
I’m on Medicare, how does that impact me with Obamacare?
If you are on Medicare A, you are considered to be adequately covered by a qualified health plan and you do not to seek additional coverage. Medicare B, however, is not considered sufficient and additional coverage would need to be obtained to avoid the Obamacare penalty.
How do I qualify for an Obamacare exemption?
There are a few exemptions to the Obamacare penalty that are available to individuals who are experiencing significant hardships. You can apply for Obamacare exceptions status through the Federal exchange. Find out if you are exempt from Obamacare in Texas.
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