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Buying ACA Health Insurance in Texas

In Texas, you can get ACA insurance in several ways. Besides getting group (ACA) insurance through an employer, ACA coverage is usually purchased by:

  1. Using a Texas-licensed health insurance agent to go over your medical and financial needs, when the agent analyzes your needs and suggests the plans that offer you the best and most affordable coverage. If you have questions, a licensed professional is able to explain the details as they pertain to your specific situation and demonstrate how the plan can cover your needs.
  2. Browsing the Texas health marketplace by yourself and comparing the plans by features, monthly cost, deductible, max out-of-pocket, and plan exclusions before filling out an application. If you have questions, you can always reach out to a Texas-licensed health insurance agent with questions. The agent's assistance to help you obtain health insurance does not cost the insured extra.

If you choose to use the local assisters, remember that assisters, unlike licensed agents, cannot make recommendations according to your needs, but they can help you fill out forms, and answer knowledge questions to a certain degree.

Do You Actually Need ACA Insurance?

You need ACA insurance if you do not have any qualifying medical coverage in Texas. In other words, people who do not have job-based insurance, coverage from a non ACA-compliant Short-Term insurer, or a government health program like Medicare need ACA insurance. It provides you with comprehensive health coverage despite your income. Hence, if you have a low income, you should get ACA insurance because it is affordable. You may qualify for premium subsidies and cost-sharing reduction benefits.

Furthermore, a person with a serious pre-existing condition, like cancer, asthma or stroke, should get ACA insurance. This is because you may be denied coverage or face high premiums if you get a non-ACA plan. ACA-compliant insurance does not discriminate based on pre-existing conditions.

Talk to a Texas state-licensed insurance agent to discuss your health insurance options based on your individual needs.

How to Shop for ACA Insurance in Texas?

You can shop for ACA insurance by at first checking out ACA plans and their prices based on your county. If you know how to compare the plan's features side-by-side, you can complete the purchase on the HealthCare.gov by yourself.

A more recommended option is to contact a state-licensed health insurance agent, who can help evaluate your needs and suggest the options of coverage that work best in your specific situation.

If you have already looked at the plans yourself, and need an explanation or help to make a decision, reach out to an insurance professional. Help of a health insurance agent in Texas is cost-free for the insured.

What are My ACA Insurance Options?

There are two major options to ACA insurance in Texas:

  1. Employer or association-sponsored group health plans, which are purchased through those organizations, and

  2. Individual health marketplace plans, which can be purchased through the Texas health marketplace or through licensed health insurance agents and authorized marketplace portals. The individual health marketplace options are given according to the amount of coverage the insurer takes on, and how much of the costs you agree to pay out of pocket:

    • Catastrophic
    • Bronze
    • Silver
    • Gold
    • Platinum

Discuss your specific needs with a licensed health insurance professional.

How to Qualify for ACA Insurance?

Almost everyone qualifies for an ACA plan in Texas. In order to qualify for ACA insurance:

  • You must be living in the United States.
  • You must be a US citizen/national or lawful resident.
  • You must be a Texas resident.
  • You must not be incarcerated.
  • You must not qualify for Medicare.

Where to Buy ACA Insurance?

You can buy ACA insurance through any of the following ways:

  • Look up an insurance agent licensed to sell health insurance in Texas, who has a large selection of options to offer, based on your medical and financial needs. The agent can make suggestions and answer your questions - all free of charge to you.
  • Online, by visiting the federal health insurance Marketplace, to research the plans based on the offered coverages and financial incentives.
  • Call the Marketplace Call Center for assistance, at (800) 318-2596
  • Complete an application form to apply via mail

Before buying a plan, you should do your research by checking out ACA plans and their prices based on your location. If you have questions, reach out to a licensed agent for an explanation.

Where Can I Buy Affordable ACA Insurance?

Regardless of the method or source of purchase, ACA's non-subsidized costs are the same within each individual county. The price will be the same if you are using the portal on the insurance agent's website or signing up for the plan unassisted on the Texas health marketplace. The nearby counties' prices may be higher or lower by up to $150, but if you qualify for subsidies, your ACA insurance may become more affordable. You find out if you are eligible for these benefits when applying for ACA health insurance. Your eligibility is based on the estimated household income for the year listed in your coverage application. You can check if your estimated household income qualifies you for lower costs. The Marketplace provides an income calculator which can be used to estimate annual income.

Generally, to qualify for ACA insurance premium credits, your modified adjusted gross income (MAGI) has to fall between 100%-400% of the Federal Poverty Level (FPL). However, if your household income does not fall within that level, you may still qualify for premium credits because of the American Rescue Plan Act 2021.

It is best to use a licensed health insurance agent to make the selection on the affordability of ACA plans. This is especially important if you want to receive advice and recommendations on what plan fits your specific needs and finances best.

How to Apply for ACA Insurance?

You can apply for ACA insurance through the health insurance Marketplace, by yourself or via a Texas licensed agent. You must sign up during the open enrollment period. This is the time of the year, typically at the end of the year, when you can enroll for ACA health coverage that will begin in the following year. If you faced a significant life event, you may apply outside the open enrollment period, during the special enrollment period. The type of significant life event could be that you got married, had a child, or lost your health coverage.

You can apply for ACA insurance through any of the following means:

  • Through a state-licensed health insurance agent
  • Online - through an agent portal or by doing the research on your own
  • By a telephone call to (800) 318-2596
  • By filling out an application form and sending it via mail
  • Making an in-person request with the assistance of an agent or broker
  • With the assistance of a local assister (Note: Assisters are unlicensed and therefore not allowed to make professional recommendations based on your needs.)
  • By using certified enrollment partner websites
  • By making a written request.

Who Can Help With Application for ACA Insurance?

You can get help with applying for ACA insurance in Texas from an agent, broker, or helper within your area. A health insurance agent represents one or more insurance companies, so they can help with information about the ACA coverage of each company they represent, and answer any questions about coverage comparison.

A broker is an insurance producer that represents you, the client. A broker is not appointed by and does not represent the insurer.

A helper (assister) is anyone with knowledge of the ACA application process within your local area. It could be someone who has purchased health insurance for many years and seems to know the process. They can give you as much information as they know, but legally they cannot make recommendations based on your needs.

Should I Use an Insurance Agent to Buy ACA Insurance?

Yes. Buying ACA insurance in Texas with the help of an agent is a smart decision. No matter if you are a seasoned health insurance buyer or someone buying insurance for the first time, if you have questions, a state-licensed health insurance agent can always help and point you in the right direction according to your needs. Health insurance agent's help does not cost extra to the insured. Using an agent also saves you time and stress.

Can You Purchase ACA Insurance Through an Agent?

Yes, you can purchase ACA insurance through a health insurance agent in Texas. If this is your first time buying ACA insurance, an agent can help with the necessary information, selecting, and buying the right plan. If this is not your first time, an agent can still help by providing you with the current year's updates of the process. Changes from year to year can result in newly available discounts or new coverage plans that may suit your current needs better.

Why Do I Need an Agent for ACA Insurance?

There are various reasons why you need an agent for ACA insurance in Texas:

  • To get all the necessary information about how ACA insurance works
  • To get the best policy that suits your medical and financial circumstances
  • For an easier and more streamlined application process
  • For timely professional insights regarding questions and inquiries that you may have
  • To get a permanent insurer representative, who becomes your communication link with an insurer. If you have issues during the policy ownership, your health insurance agent can usually solve them on your behalf.
Why is an Insurance Agent Important for ACA Insurance?

An agent is important for getting ACA insurance because they help you buy the appropriate ACA plan for you. They also help you understand your coverage terms. Furthermore, an agent can help you when you have issues with making an insurance claim.

What Kind of Insurance Agents Work With ACA Insurance?

Agents represent insurance companies to sell, negotiate, and effect insurance contracts. ACA is health insurance, so the agent selling it must have a Texas health insurance agent license.

There are two kinds of health insurance agents that work with ACA insurance in Texas: captive agents and independent agents.

A captive agent works for one health insurance company or group of companies. They cannot provide you with information about the insurance products of another health insurer, even if it might suit your circumstances better.

An independent agent works for and represents more than one insurance company. They can choose the insurance companies they want to work with and offer their products to clients. Because they sell multiple insurance products, they provide clients with many options.

The key issue is that some Texas licensed insurers do not allow independent agents to represent them, so if you want to use that particular insurer - you must use their captive agents.

How to Choose an Agent for ACA Insurance?

Both Captive and Independent agents can be very useful. If you prefer to examine all available options before getting your plan, you should consider an independent agent. However, if you know the company you want coverage from, and if it works only with captive agents, you can just talk to their agent directly.

What Do Insurance Agents Do for You in ACA Insurance?

Having an insurance agent help you with ACA insurance selection and purchase is very beneficial. Your Texas-licensed health insurance agent helps you in several ways:

  • Agent asks you questions about your current and expected medical needs, in order to find out what are the most important features of the insurance coverage for your particular situation. The agent uses their knowledge of the market and the available products to make suggestions.

  • Agent asks you about your financial needs, to determine how much you can afford to pay for the coverage. This discussion goes over the monthly costs (premium), and the percentage of bills that you can afford to pay once you start using the coverage, like the deductible, co-insurance, and maximum out-of-pocket. In the process, the agent answers all of your questions, so you should ask them for an explanation of everything you are not 100% sure of.

  • If the agent determines that you may qualify for ACA subsidies, the agent helps you to submit all the required paperwork to prove this level of income to the health marketplace.

  • The agent suggests you options of plans fitting your particular circumstances and the desired costs. If the agent determines that an alternative health insurance plan may work better to fulfill your needs - they may offer you those options.

  • The insurance agent acts as an authorized representative of the insurer, even if they are independent. This means that the agent becomes your link to the insurer, where they can help you resolve any issues you may have during the life of the policy.

  • Whenever you want to switch to a new plan, reach out to your agent and they can help you with ease, because they already have your information and can quote you fast.

The bottom line is that the agent can be an invaluable source of information and help, all the while not costing you - the insured, anything extra.

What Should Your Health Insurance Agent Do for You?

The most important thing an agent should do for you is make sure you get the plan that fits you, both in terms of your medical needs and financial situation. Health insurance agent should give you comprehensive information about all the available options, help you with your application, and assist you with resolving any issues with the insurer during the life of the policy.

How to Compare ACA Insurance Quotes?

Unlike with other types of health insurance, comparing quotes of ACA insurance is rather straight-forward. You can check out different ACA plans available on the marketplace and their prices based on your location.

The advantage of comparing quotes yourself is that you have information about all the plans and can pick a very economical plan. On the other hand, if you compare quotes without professional help, you may end up picking a cheap plan that does not provide you with the coverage you need, because you did not fully understand or verify the terms of the plan.

Once you have reviewed your marketplace options, reach out to a Texas-licensed health insurance agent to discuss what you saw and any resulting questions you may have. The agent may be able to give you additional options of other insurers meeting your coverage needs, who may not be represented on the main marketplace.

When comparing ACA health insurance plans, you should concentrate on a few things (in order of importance):

  1. Maximum out-of-pocket (MOOP) is the maximum amount that you will be required to pay for a year, if you need to actually use the plan. If you have a medical emergency, no matter how expensive the treatment gets, MOOP is your maximum expenditure for the year for covered services.
    • MOOP includes the deductible
    • MOOP includes coinsurance
    • MOOP includes copay
    • MOOP does not include monthly premiums
  2. Deductible in ACA can be as low as $0 and as high as $8,700. Remember, deductible in ACA insurance is included in MOOP (this is not so for alternative Texas health plans).
  3. Coinsurance is your share of the costs that get split with the insurer, after the deductible is paid. Coinsurance in ACA plans depends on the metal tier of the plan: Bronze (60/40 - 60% of the claim is paid for by the insurer / 20% by you); Silver (70/30); Gold (80/20); Platinum (90/10).
  4. Copay is a fixed amount that you may be required to pay for covered services, such as doctor visits, specialist visits, and prescriptions.
  5. Premium payment in ACA insurance is the most misleading number. In some cases you may qualify for a $0 (free) monthly ACA premium. While this can be great for someone who does not need a lot of treatment, those plans usually have high deductible and high MOOP. So, if you have a low premium plan, you might actually spend more if you really have to use your plan. If you know that you need a lot of treatment, it is almost always worth it to get a more expensive premium, which results in lower overall MOOP

The premium you pay is the same, regardless if you purchase the plan yourself or if you used professional help to make the selection. Always discuss any questions you have about insurance with a professional, who can help you avoid making a mistake of getting a wrong coverage. .

How Many ACA Insurance Quotes Should I Compare?

There are no restrictions on the number of quotes you should compare. You should compare at least three quotes. Generally, when you get more quotes, it means you have more options. This is where an insurance agent is useful, as they will save you the time and stress involved with comparing quotes.

How Important is to Have a Local Agent for ACA Insurance?

When it comes to ACA insurance, Texas-licensed health insurance agents make it simple to understand your options. A licensed agent understands the insurance products currently being offered on the state's market, and is able to offer and justify those options based on your needs. An agent continues working for you even after the policy has been purchased. The agent is there to help you with the policy while it is in effect.

Local agents are becoming less important with an extensive use of video conferencing technology. Any Texas-licensed health insurance agent with an extensive selection of products can help with ACA insurance.

Does it Cost Me Extra to Use an Insurance Agent for ACA Insurance?

No. It does not cost you extra to use an insurance agent. The commission a Texas health insurance agent receives for selling a plan is already built in the cost of the advertised plan by the insurer. Commission is paid to the agent by the insurer whose coverage was purchased. Thus, a plan does not cost more because you used an agent's help to get the plan.

How Does an ACA Insurance Agent Get Paid?

An insurance agent gets paid in commission by the insurance company they represent.

Captive agent is on a payroll or commission of their employer insurer.

Independent agents receive a commission every time they assist with filling out and submitting the application to the insurers with whom they have agreements. This commission comes from a marketing fund that the insurers maintain to pay professionals who make sure that the application is done right - the first time. Hence, it is the insurance company that pays the agent for their service, not you.

Can I Buy ACA Coverage Online?

Yes. You can buy ACA health insurance online from two main sources:

  • Health insurance Marketplace.
  • Authorized online agency portals, which are linked to ACA insurers that may or may not be present on the main state marketplace.

Can Anyone Get ACA Insurance?

Yes. Every citizen or legal resident of the United States, who is not incarcerated or qualified for Medicare, can get ACA insurance. These federal rules apply inside Texas.

Can You Obtain ACA Insurance at Any Time?

No. Generally, there are only two periods that you can get ACA insurance. These are the open enrollment period and the special enrollment period.

Obtaining group health insurance coverage through an employer happens based on the employer's Human Resources and group plan rules. Some employers offer coverage from the first day, while others may enforce a hiring trial period of 90 days or more, after which the coverage begins.

How Do I Renew My ACA Insurance?

The agent who helped you purchase the current plan should reach out to you at least once a year, to check if your medical and financial situation may have changed, necessitating the possible change to a better suited health insurance solution.

If you do not expect any changes and you want to renew the plan as-is, you can do so by logging into your HealthCare.gov account, updating your application, and choosing your existing plan. Usually, your current plan is automatically chosen for you during the open enrollment plan, but it is best if you confirm that your current plan was automatically chosen for you. The plan does not start until you pay your first premium.

You can also renew your ACA plan by calling the Marketplace Call Center at (800) 318-2596 or talking with a Texas-licensed health insurance agent to help you renew your ACA coverage.

You renew your ACA insurance during the open enrollment period. The open enrollment period typically falls towards the end of the year. It is the time when you can make ACA insurance decisions, like renewing your ACA plan, that will take effect the following year.

What Kind of ACA Insurance is Best?

Deciding what ACA insurance is "best" is very subjective.

For instance, a bronze or catastrophic plan provides suitable coverage for a young healthy person because it allows them to pay low premiums. Since they will most likely rarely go to the hospital for treatment, they can save and only have medical bills when receiving medical care.

A silver or gold plan may be better suited for a family with different age groups. Gold or platinum plans are best for an older person, or anyone with a pre-existing condition, since they are more likely to have expensive medical bills. The top metal tiers provide the insured relief, by letting the insurer cover the majority of the costs.

A licensed insurance agent in Texas can give you more information about all the ACA insurance plans available in your county, and the one that is ideal for you.

What is the Best ACA Insurance for Texas' Self-Employed?

A self-employed Texas business is the one where a person receives income, but the business does not have other employees. A contractor receiving 1099 (non W-2) income from multiple sources is an example of a self-employed individual.

There is no single best ACA insurance for the self-employed in Texas. All ACA Marketplace plans cover the same categories of essential health benefits and cannot deny you treatment due to pre-existing conditions. You can also choose between plans with lower premiums but higher cost-sharing when you require care and plans with higher monthly premiums but reduced cost-sharing. If your income level allows (100%-400% of the Federal Poverty Level), you may qualify for subsidies (discounts) that can make ACA more affordable.

To get the best coverage for you, your family, and your business, talk to a licensed health insurance agent in Texas. Professional agent can assist you in getting the coverage you need at no extra cost to you.

In some cases, ACA may not be the best option for your needs, and your Texas-licensed agent is able to explain the alternative options that you can take. For example, if you are able to organize several people as employees and/or family members, you could get a group health insurance plan, which by default is ACA-compliant. Or you could explore the Texas Short-term insurance market, to maximize the savings, if you are healthy and without the pre-existing conditions.

Talk to a knowledgeable agent who can explain to you the pros and cons of your decisions.

What Kind of ACA Insurance Plans are Available in Texas?

Generally, there are four ACA insurance plans in Texas. Organized in order of how much cost you and the insurance company will share, the plans are:

  • Bronze plan - Your insurer covers 60% of your medical bills, and you cover the remaining 40%
  • Silver plan - Your insurer covers 70% of your medical bills, and you cover the remaining 30%
  • Gold plan - Your insurer covers 80% of your medical bills, and you cover the remaining 20%
  • Platinum plan - Your insurer covers 90% of your medical bills, and you cover the remaining 10%

Speak with a registered insurance agent in Texas to determine what ACA coverage you require.

Can I Bundle ACA and Dental Insurance?

Yes. While adult dental insurance is not part of the essential health benefits of ACA insurance, you can bundle dental coverage with ACA as a supplemental plan. This purchase can be done at any time, without having to wait for the Open enrollment or special enrollment timeframes.

How to Reinstate ACA Insurance that You Stopped Paying?

You may or may not be able to reinstate an ACA plan that you stopped paying. It is the insurance company that will decide whether you can still enroll in their plan. An insurance company can deny you coverage under their plan because you failed to pay premiums when you were under the plan. Thus, you need to contact the insurance company. Alternatively, you may speak to a licensed agent in Texas to discuss your options.

How to Find Out What ACA Insurance I Have?

You can either log into your HealthCare.gov account or contact your insurance company to confirm that your coverage is still active. You can also get confirmation from the health insurance agent that helped you purchase the plan.

How Do I Find Out My ACA Insurance?

You can find out your ACA insurance by:

  • Checking your insurance policy documents, or by
  • Logging into your HealthCare.gov account, or
  • Contacting your insurance company, or
  • Reaching out to the agent who assisted you with the purchase. They are your official link to the insurer, and they have a fiduciary duty to you, to help with any issues that may arise with coverage.

How Do I Know if I Have ACA Insurance?

You have ACA (major medical) insurance if:

  • You have a group health plan (through an employer or an affiliation to an organization), or
  • You purchased health coverage on the individual Texas health marketplace (by yourself or using an agent)

To find out if you have ACA insurance, check your policy documents or check your HealthCare.gov account, under the "My applications & coverages", where you can see the summary of your coverage.

Alternatively, check with your insurance agent, who will be able to answer all your clarification questions.

Can ACA Insurance Be Combined with Other Insurance to Become More Affordable?

Yes, you can combine ACA insurance with another health plan in Texas. There are various situations where you can have two health plans, like:

  • An adult under 26 years who has health insurance both through parents and employer
  • A married couple with health insurance through both their employers
  • A person under 26 years old with married parents who have separate health insurance policies, who is listed as a dependent in both plans
  • A person under 26 years listed as a dependent under the separate health plans of their divorced parents
  • A married person under 26 years covered by both their spouse's and parents' plan.

The fact that you have two health coverage does not mean you get reimbursed twice for getting services covered by both plans. The total amount that both plans will pay will not be more than 100% of the expense incurred. Through what is called "coordination of benefits", one plan pays your claim first to its coverage limit. Then the second plan covers the rest of the bill. The first plan is your primary insurance, while the second plan is your secondary insurance. Both cover costs up to their limits.

Also, you can combine ACA insurance with supplemental insurance plans, such as: accident insurance, travel insurance, dental, or vision insurance. These plans cover risks that the ACA plan does not cover. For example, the ACA does not offer dental or vision care as part of the essential health benefits, but you can get a supplemental plan for it.

If you are looking for a way to lower the monthly health insurance costs, especially through the combined use of alternative and supplemental Texas health insurance plans, you must discuss your options with a knowledgeable Texas-licensed agent, who has access to different types of insurers. Only a licensed professional may give recommendations for the health insurance plans based on the needs of the specific client.

Is ACA Insurance a Good Deal for Texans?

Yes. ACA insurance is a good deal, especially if you have pre-existing conditions. Coverage wise, ACA-compliant insurance plans provide the most comprehensive set of coverages and preventative services.

ACA insurance provided by the employer is guaranteed to be available for less than 10% of the employee's annual income. The employer usually also pays a significant portion of the monthly premium, making ACA a great deal for employees.

Similarly, Texans who qualify for subsidies benefit from the lower insurance costs while receiving good coverage at the time of need.

On the other hand, if the applicant does not qualify for financial assistance, the cost of ACA health insurance increases according to the income level.

The price issue aside, ACA-compliant insurance remains the safest bet if you need comprehensive health coverage. If you qualify for subsidies or can afford the full cost of ACA, it is the best thing you can have in the US health market.

Under ACA, no plan can deny you coverage or refuse to pay for your essential health benefits. Once you sign up for a plan, you cannot be refused coverage or asked to pay higher premiums because of your health. If you have pre-existing conditions, ACA is a good and usually your only option on the Texas market.

Check the health insurance Marketplace - Healthcare.gov, to see the various available plans and talk with a licensed health insurance professional, to go over your Texas health insurance options, based on your specific needs.