Health Insurance
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Put your health and well-being first with Marketplace health insurance. You can compare plans and find out what your costs will be before you enroll. You may qualify for savings, even if you haven’t before!
The Health Insurance Marketplace® provides health plan shopping and enrollment services for individuals and families (the individual market), as well as employees of small businesses [the Small Business Health Operations Program (SHOP)] through websites, call centers, and in-person assistance.
The Marketplace will determine eligibility for:
Coverage in Marketplace plans
Advance payments of the premium tax credit (APTC) toward monthly premiums
Cost-sharing reductions (CSRs) to lower what consumers pay for out-of-pocket costs, like deductibles, copayments, and coinsurance
Medicaid and the Children’s Health Insurance Program (CHIP)
What is the Affordable Care Act (ACA)?
The Affordable Care Act is often referred to as Obamacare since it was signed into law in March of 2010 by President Barack Obama. Under the ACA, those who were previously uninsured due to preexisting conditions or financial circumstances and those who were insured in high premium plans or limited benefit plans may now be eligible for discounted health plans.
Customer Benefits
Unlimited primary care for $0
Unlimited tele-health for $0
Discounted prescription drugs
Discounted emergency services
Pediatric dental and vision coverage
Discounted maternity care
Discounted lab services
Marketplace plans must provide coverage for the following items and services in the 10 EHB categories:
Ambulatory patient services (like doctor and clinic visits)
Emergency services (like ambulance, first aid, and rescue squad)
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices (like, therapy sessions, wheelchairs, and oxygen)
Laboratory services
Preventive and wellness services and chronic disease management (like blood pressure screening, and immunizations)
Pediatric services, including dental and vision care
To be eligible to enroll in a Marketplace plan, you must:
Meet ACA income eligibility
Not be enrolled in Medicaid
Not be enrolled in Medicare
Be between 18-64 years old
Be a US Citizen, or have proper documentation
Income Eligibility
*Please note that income eligibility is based on the number of people in the household. For example, someone who is married and has 2 dependents would be considered a 4 person household.
Texas Monthly - 1.4 Million More Texans Could Have Free Health Insurance
They just don’t apply, according to a new report that says many uninsured residents aren’t taking advantage of Affordable Care Act plans.
December 22, 2023
"Texas holds the dubious distinction of leading the nation in medically uninsured residents, by a lot. There are more Texans without health insurance than there are residents of Louisiana, the twenty-fifth most populous state. Getting by on a hodgepodge of free or low-cost (often inadequate) care, or piling up a mountain of debt they’re not likely ever going to be able to pay back, Texas’s 4.9 million uninsured residents—a staggering 16.6 percent of the population, more than twice the nationwide rate—live with this constant medical and financial vulnerability.
Yet according to a report released last week by the nonprofit think tank Texas 2036, nearly a third of the state’s uninsured residents—some 1.4 million Texans—already qualify for premium-free health insurance. All they need to do is apply for coverage through the health insurance marketplace created by the ACA.
Charles Miller, a senior policy advisor at Texas 2036 and a former staffer for Governor Greg Abbott, was stunned after digging into the data and determining that 29.2 percent of uninsured Texans were likely already eligible for free health insurance.
When the ACA was enacted in 2010, it required all fifty states to expand Medicaid eligibility to nearly all adults earning up to 138 percent of the federal poverty level. But the U.S. Supreme Court subsequently ruled that states had to opt in to the expansion. Texas is one of ten that has declined to do so. Each state sets its own parameters for who qualifies for Medicaid, and Texas’s are especially limited. According to the Texas 2036 study, 15.3 percent of uninsured Texans—about 750,000 residents—fall into the coverage gap, meaning they don’t qualify for Medicaid or an ACA marketplace subsidy.
But a much higher percentage of uninsured Texans—47.6 percent—have household incomes of at least 100 percent (and no more than 400 percent) of the federal poverty level, and are thus eligible for subsidized plans via the health insurance marketplace. After the passage of 2022’s Inflation Reduction Act, more federal money was made available for marketplace subsidies, thereby increasing the percentage of uninsured residents eligible for premium-free plans to the 29.2 percent reported by Texas 2036."
