The price of Affordable Care Act (ACA) insurance in Texas is not fixed, as it varies depending on the insurance company. Typically, your insurance company decides the cost of the ACA coverage they offer. The cost is determined based on six factors including your age, income, family size, location, tobacco use, and plan category.
While the monthly cost of ACA in Texas varies, below is the common premium range for each plan (excluding premium plans) in the state*:
*Figures represent individual plans and do not include possible discounts from subsidies.
Speak to a licensed insurance agent in Texas to get all the up-to-date information about ACA insurance in Texas.
The cost of ACA insurance in Texas varies depending on your age, income, family size, location, tobacco use, and the amount of coverage offered by the chosen plan. Also, depending on your income, the ACA may provide you with premium tax credits and cost-sharing reduction benefits to make the coverage more affordable. Without these benefits, an average typical single Texas bronze plan premium is $350, a silver plan premium is around $450, and gold is $540 per month.
The application of the subsidies that ACA provides can reduce the cost of your premium significantly. There are even healthcare plans with $0 monthly premiums after the cost benefits of ACA kick in.
With that in mind, the plans are usually compared to each other by their Maximum out-of-pocket amounts , which is the real cost of this coverage, if you need to use health insurance for an emergency or to get an expensive treatment. Check out ACA plans and their corresponding prices based on your specific location and reach out to a state-licensed health insurance agent, to get their professional advice on what coverage is best for your specific needs.
Typically, you can make four types of payments when enrolling in an ACA-compliant health insurance plan:
Premium: ACA Premium is the money you pay to the insurance company every month for providing you insurance coverage. Six main factors determine the cost of ACA insurance premium: your age, income, family size, location, tobacco use, and plan category.
First, your age is an important factor in determining your premium rate. Insurers usually charge older people higher premiums, however, ACA insurers cannot charge premiums for older persons more than three times higher than for young persons.
Second, your place of residence also plays a key role with premium rates. Some cities have higher living and medical costs than others, driving the overall health insurance costs up.
Furthermore, your income and family size are the most interdependent factors. Usually, an insurance company charges higher premiums for a health plan covering more than one person.
The ACA offers various cost benefits to individuals and families in the form of premium subsidies and cost-sharing reductions. A subsidy is in effect a discount that gets applied to the full price of the ACA plan purchased on the marketplace if your income is between 100 and 400 percent of the federal poverty line (FPL).
(In 2022 ACA expanded the coverage and subsidies to some other groups of people. Reach out to a licensed health insurance agent to find out if you may be eligible to get a discounted plan on the health marketplace.)
In order to understand how subsidies work on the Texas ACA health insurance marketplace, it is important to see how ACA spans across group and individual health insurance and where all the numbers connect:
All employer group health insurance plans must meet the requirements of the ACA level of coverage, therefore all employer-sponsored healthcare is ACA-compliant. This means that the type of coverage and benefits you get from an employer health insurance is on the same level as you would get from the Texas individual health marketplace.
Every year the Internal Revenue Service (IRS) publishes an Affordability Threshold (AT). The affordability threshold is a percentage of the income amount listed as the federal poverty level (FPL) for that year. This amount is considered by the ACA as affordable for an employee to pay as their portion of an employer-sponsored health insurance plan. This amount establishes the benchmark plan for each individual, which is also referred to as the second-lowest-cost Silver plan (SLCSP). SLCSP is tied to a specific price. The insured is given an option to get SLCSP, one plan for even less, and multiple others priced higher.
(Affordability Threshold multiplied by Federal Poverty Level) divided by 12 months
This means that in 2021, with an FPL of $12,880 and the affordability threshold of 9.83%, a single person Silver level plan offered through an employer in Texas was available for not more than $105.50.
($12,880 x 9.83%) / 12 = $105.50
If the lowest pay in the company allowed, the contribution from the employee could be raised above $105.50, as long as it was not more than 9.83% of their salary. In addition to this affordable benchmark Silver plan, an employer may have offered a whole variety of custom health insurance plans, which are all optional and custom-priced.. All of them are the variations of the ACA-compliant plan.
Besides getting ACA coverage through work, ACA insurance can be also purchased by individuals on the Texas individual health marketplace and through various portals offered by insurance agents and agencies. This combination of sources functions as an alternative way for Texans to get health coverage if one was not offered at the place of employment. While different, the calculations of the subsidies are based on the same sources as explained above.
For the private health market, the affordability is calculated using the modified adjusted gross income (MAGI), the federal poverty level (FPL), and the Multiplier according to where you fall within the 100-400% FPL scale.
A key change instituted for ACA plans in 2022 was the expansion of the $0 coverage to include the people in a 100-150% FPL: Anyone above 150% FPL paid no more than 8.5% of their MAGI to get the benchmark Silver plan.
|% of FPL for 1 person
|Max. annual contribution
|Max. monthly contribution
Additionally, as of 2022 Texas no longer deferred to the federal rate review program, a move meant to increase the amount of subsidies received by eligible Texans. This new expansion attracted multiple ACA-compliant insurers that did not previously participate in the Texas state health marketplace, to join.
Advance Premium Tax Credits (APTCs) are the actual discounts you may get. They are calculated based on the premium cost of the benchmark "Silver" SLCSP plan listed on the individual marketplace. Each county's benchmark price is different, which means that the person residing in San Antonio (Bexar County) will be looking at a completely different premium than a person with the same income and life circumstances residing in the neighboring Medina or Guadalupe counties. In some counties within Texas, the difference can be +/- $150 on the identical plan.
APTC Example 1:
APTC Example 2:
As you can see in two examples, while the starting price of the plans in each county are different, the application of the APTC makes the plans cost the same regardless of which county you live in. The base cost goes up, so does the credit. The price goes down, so does the credit.
Note: Your insurers will also use how much tobacco or nicotine you consume to determine your premium. They may charge tobacco users up to 50% more than persons that do not use tobacco.
In addition to the Silver benchmark plan, your plan category determines how much your monthly premiums will cost. While all ACA plans have the same essential health benefits, five plans stipulate cost-sharing of medical care between you and your insurer. These plans determine how much you and your insurance company will pay for healthcare.
The 5 ACA plans are:
Note: The ACA-compliant insurance plan cannot charge you a different price because of your gender or a pre-existing condition.
Deductible: It is the part of the claim you pay before your insurer starts paying any claim benefits. In Texas, your deductible primarily depends on your ACA plan. Generally, if your deductible is low, you will have high premiums and vice versa.
Coinsurance: This is an agreement between you and your insurer that determines which of the both of you will pay a particular amount of your medical bills. Your plan category prescribes the range of possible ACA plans. With Bronze plans, the split is 60/40 for your insurance company and you, respectively. That is, your insurance company pays 60%, while you pay 40%. Silver plans and Gold plans are shared 70/30 and 80/20, respectively.
For example, if a medical bill is $4,000 and you have already paid your annual deductible on a Gold plan - your coinsurance cost will be 20% ($800), while your insurance covers the remaining $3,200.
Copayments: This is an agreement where you pay a certain amount for medical services "upfront," and your insurer pays the rest of the cost. Copays are common for health insurance plans. If you want to visit the doctor's office frequently throughout the health insurance term, you might consider getting a copayment.
Out-of-Pocket Maximum: ACA-compliant insurance plans are required to abide by the out-of-pocket maximums. These amounts are set by the Federal Marketplace to limit how much an individual and a family may pay for their covered health care throughout the year, in addition to the monthly premium.
2022 - $8,700 (individual) / $17,400 (family)
2021 - $8,550 (individual) / $17,100 (family)
2020 - $8,150 (individual) / $16,300 (family)
2019 - $7,900 (individual) / $15,800 (family)
Max out-of-pocket does not include: premiums, non-covered services, out-if-network services, and costs above the allowed amount.
Maximum Out-of-Pocket (MOOP) is considered on one of the key defining comparison tools between the ACA plans.
Overall, you should compare each plan category's monthly premiums, deductibles, copays, coinsurance, and most importantly - annual out-of-pocket maximums. That is when things may get complicated. Even within the same plan category, the lowest premium plan may have the largest deductible. By implication, it may cost you more in the long run. If you get sick, you may end up paying more for health care than you would with a plan with a higher premium but a smaller deductible. So you must first estimate your actual healthcare cost needs and then choose the insurance plan that will help you save the most money overall. Consider contacting a licensed health insurance professional in Texas to assist you with estimating the cost of your medical needs and finding the best fitting health coverage for you. Reach out to a pro to ask clarifying questions or to get help with making the choice.
The price of the plan for the consumer remains the same, whether you apply for the coverage yourself or if you use a professional to guide you through the process or even do it all for you.
The average cost of ACA insurance in Texas varies depending on your circumstances and can be analyzed in several ways.
The average ACA insurance premium in Texas can range from $250 for a Bronze plan to $506 for a Gold plan. These prices may be lower or higher, depending on how much coverage you want, your income, and whether you qualify for premium subsidies. Utilizing the subsidies, the same $506 Gold plan can cost you less than $100 per month.
The most important thing to remember is that the maximum-out-of pocket (MOOP) amount determines the real cost of the ACA plans. Monthly premium payments are not a part of MOOP.
Using the same Gold plan example from above, the non-subsidized $506 plan is likely to have a high deductible and a maximum out of pocket amount (of around $6,000). So, if you actually needed to use your ACA insurance for extensive coverage, your average annual cost of non-subsidized policy in this case is $12,072 (($506 x 12) + $6,000).
The subsidized $100 version of the same plan can come with a deductible as low as $400-$600. The average annual cost of ACA insurance in this case is $1,800 (($100 x 12) + $600).
Employer and group insurance plans are also considered ACA. The cost of such plans has a lot of variables based on the coverage offered, but as a national average, the employee cannot be required to pay more than 9.61% (2022) of their salary for the basic (Silver) employer provided coverage.
Because the cost of ACA insurance varies greatly on your medical needs and even more so on income, it is best to discuss your needs with a state-licensed insurance professional, who can help you figure out what type of plan is best for you.
The typical ACA health insurance pricing model consists of a premium, the deductible, and an out-of-pocket maximum. When you look at them, you are assessing the total maximum dollar amount that you will have to spend on insurance in case you need to use it's coverage a lot, or in case of an emergency.
For a typical 40 year-old single resident of Texas, the unsubsidized ACA plan costs around $10,500 per year:
Max out-of-pocket: $4,500/yr.
($500 x 12) + $4,500 = $10,500.
*ACA max out-of-pocket includes the deductible, so it is already covered.
While with the subsidies, the same plan can theoretically go down in total costs to approximately $1,700:
Max out-of-pocket: $500/yr.
($100 x 12) + 500 = $1,700
Again, the max-out of pocket includes the deductible and one covers the other.
The cost of ACA insurance premiums differ based on factors like age, income, family size, location, tobacco use, and plan category. Using the 40-year-old person as an example, below is the estimate of monthly and yearly premiums for the five plan categories:
This estimate does not include premium subsidies for which you may be eligible.
There are four types of ACA plans:
Using the example of a 40-year-old person below is the estimate of monthly and yearly premiums for these plan types:
Without discounts from premium subsidies or cost-sharing reductions, an ACA plan without supplemental coverage in Texas can cost $300-750/month ($3,600-$9,000 per year) for a single 40 year-old person. Deductible may be between $0 and $8,700, and the maximum out-of-pocket can be as low as $4,500 or as high as $8,700.
If the same 40-year old applicant is also a tobacco user, the monthly premium cost range goes up to $320-800.
This is the cost before applying for premium tax credits, which is available to anyone whose income falls between 100% and 400% percent of the Federal Poverty Levels (FPL) or qualifies for subsidies under the American Rescue Plan Act.
With the subsidies applied, the single 40-year old's plan may be obtained for $0 monthly cost, but it will most likely have a significant deductible and maximum out-of-pocket (up to $8,700 attached to it).
The cost of ACA insurance largely depends on the size of the household, plan category, and the max out of pocket amount of the plan.
For example, a non-subsidized ACA Gold plan for a family of four can have a maximum out-of-pocket cost around $17,400 ($8,700 per person) in a year if it gets used extensively throughout the year, or in case of an emergency.
When you purchase a family plan, each family member gets an individual deductible, which is a part of the large family deductible. If half of the family maxes out their annual deductibles, the out-of-pocket max is met and the plan starts covering the whole family at 100%
The average premium ranges of non-subsidized family ACA plans in Texas in 2022:
|FAMILY OF 4 (SILVER Plan)
|FAMILY OF 4 (GOLD Plans)
|$1,200 - $1,600
|$1,200 - $2,000
|$1,200 - $1,900
|$1,350 - $1,900
|$1,300 - $1,750
|$1,200 - $2,000
|$1,200 - $1,850
|$1,400 - $2,200
|$1,400 - $2,100
With the application of subsidies, the premium cost can be significantly decreased. Contact a licensed insurance agent in Texas to get a good estimate of how much ACA insurance will cost your family.
An ACA insurance policy does not have a fixed cost. Insurance companies determine your premiums based on factors like your age, income, location, family size, tobacco intake, and plan category. There are also other things like deductibles, coinsurance, and copayments.
Let us use the following information as an example to understand how much an ACA insurance policy may cost:
To qualify for the coinsurance plan, you must pay your $400 monthly premium and meet your deductible fee amount. When you have paid up the $1,500 deductible, the plan covers medical costs and you pay 30% of your medical bills.
During this time, you may be paying 30% while your insurer pays 70% of all medical expenditures until you reach your out-of-pocket maximum, which is $8,700. Your insurer will pay for all your medical bills until your ACA insurance expires when you reach this stage.
So, let's say you get a kidney stone and end up in a hospital. After a few days you are released with a bill north of $50,000. How does this play out?
At first you must continue to pay your $400 monthly premium, then pay your $1,500 deductible before the insurance starts realistically contributing. After the deductible is paid up, you start paying 30% of the covered costs until you reach your out-of-pocket limit.
In ACA insurance, deductible is included in the out-of-pocket maximum, but the premium is not, so after you have paid your $1,500 deductible and $7,200 in coinsurance out of pocket, you have reached your $8,700 out-of-pocket limit. In effect, this $50,000 medical expense costs you your Max out-of-pocket amount plus the monthly premium ($400 x 12) + $8,700 = $13,500).
Your insurance cost for the year is $13,500, and your insurer covers the remaining $36,500. Without insurance the bill would have been a lot higher and you would owe all of it.
Comparing multiple market options is the simplest way to determine how much an insurance policy costs. Talk to a Texas insurance agent to know more about your options.
Some ACA insurance plans have high deductibles. These are bronze and catastrophic plans. The ACA gives you the ability to choose between paying high premiums or high deductibles. A high deductible plan is one where the monthly premium is lower, but you pay more medical costs yourself before your insurer begins to pay its portion.
Note: According to the IRS, if the annual deductible of your health insurance plan is more than $1,400 for an individual or $2,800 for family, you may qualify for a Health Saving Account (HSA), to help you with covering those medical costs in the time of need.
Yes, the higher a plan's deductible, the cheaper the premium cost. And the higher the premium cost, the lower the deductible plan. When you pay extra for care upfront, you save money for the monthly premium. Furthermore, if you pay a higher premium with a lower deductible, your spending may become more predictable.
ACA insurance is usually not expensive, particularly for middle and low-income earners, who may get federal assistance paying for the plan. Because of the ACA, monthly premium prices dropped by an average of 40% due to the boost in subsidies from government stimulus funds. Most ACA enrollees qualify for premium tax credits to make their monthly premiums affordable. These subsidies protect enrollees because if their premium increases, their subsidy also increases. Before 2021, access to premium subsidies was restricted to people whose income was below 400% of the Federal Poverty Line. However, through the American Rescue Plan Act (ARP), access to premium tax credits has increased to persons from all income categories (low, middle, and high). As a result, many people across all household income levels may be eligible for lower premiums.
If you have any questions, you should discuss your options with a licensed Texas insurance agent to learn more about the cost of ACA insurance.
The simple answer to this is that you have a wrong health plan. Let's say from the plan categories, you got a platinum plan, which has the highest premiums and lowest deductibles. If you are healthy and hardly need medical care, you will be spending more on healthcare than necessary. This is because you pay high premiums for coverage that you do not use. It will be wiser to get a bronze or silver plan, where you can save money and get good health coverage. With bronze or silver plans, you only pay more when you receive medical care. Your premiums are lower.
Generally, the cost of your ACA insurance depends on factors that relate to you alone. That is where you live, your age, the extent of coverage you want, and your estimated yearly income. First, you can estimate your household income for the next year to know how much ACA health insurance you can purchase. Based on your income, you can check out plans available to your location. ACA goes on to offer low-cost plans that allow you to save on health insurance by providing premium subsidies and cost-sharing reductions.
The best part of this is that all the plans provide you with access to comprehensive health care because of the essential health benefits they offer. The cost of your plan does not affect the quality or standard of healthcare you receive.
Overall, licensed insurance agents in Texas give the best advice on ACA insurance prices and plan categories. Consider talking to an insurance professional to go over your current insurance, to see why your ACA insurance is so high.
The cost of your premium increases or decreases based on many factors. These are your:
No. ACA premium rate does not go up after a claim or several claims. Unlike auto insurance products, the premium rate for ACA and other health insurance plans is fixed. It does not increase or decrease because you made many claims.
Your ACA insurance is fixed upon enrollment. Filing a claim does not increase the cost of an ACA health insurance plan.
If you are involved in an accident, you will be primarily responsible for covering your medical bills that arise from the accident. You may be able to get compensation later from the at-fault driver's auto insurance (if they had it). However, the accident will not increase your ACA insurance cost.
You should speak to a licensed insurance agent in Texas to know how you can go about situations like this.
The cheapest ACA plan is the bronze plan. The Bronze plan has the cheapest monthly premiums but the most expensive deductibles and out-of-pocket costs. The insurer covers 60% of your medical bills, while you are responsible for the other 40%. A bronze plan is a good option if you want a less expensive way to protect yourself from the worst-case medical scenarios, such as catastrophic illness or injury.
You can either sign up for a new plan during the open enrollment period or renew your subscription with your old plan. Every enrollment period, your insurance provider sets your premiums based on factors like your age, income, family size, location, tobacco use, and plan category. Hence, your premium rate may increase or decrease based on these factors.
The amount of ACA insurance you need is determined by your income and the coverage you require. When determining how much ACA coverage you require, you must consider both of these factors. Fortunately, the Affordable Care Act (ACA) provides subsidies and cost-sharing reduction advantages, making plans more affordable. Based on your income, you can see if you are qualified for subsidies. You may also use the income calculator to estimate your earnings.
In general, if you want to find out how much ACA insurance you need, you should contact a Texas-licensed agent to help you out.
The amount of ACA insurance coverage you require or should obtain is primarily determined by your financial ability to meet your medical needs. For example, if you have surgeries scheduled throughout the year, you may want to choose the plan with the lowest deductible.
In general, four metal levels determine how much of the cost will be split between you and the insurance carrier. They are as follows:
Speak with a registered insurance agent in Texas to determine what ACA coverage you require. An agent will offer you all of the required information and variables to guide you in making the best selection possible. Alternatively, you can check the health marketplace yourself and browse the plans. If you have any questions, ask a licensed professional for guidance and suggestions on which plan might work better for your situation.
Yes, getting ACA insurance through your employer or an association is usually much cheaper than buying it from the individual Texas health marketplace, especially if you do not qualify for government subsidies due to income limitations. Employer-sponsored health insurance is typically less expensive because employers pay for a part of the cost of the plan. Under federal law, large employers must pay at least half of their employees' health insurance premiums.
You can save on ACA insurance premiums by checking if you qualify for premium tax credits or cost-sharing reductions. ACA insurance offers plans that allow you to save on premiums and get lower out-of-pocket costs, like deductibles and copayments, based on your income. It provides premium tax credits and cost-sharing reductions. Your state of residence, the number of people in your household, and your projected income range for the year are all you need to submit.
The subsidy is based on your income for the full year, so you need to estimate how much you will earn during the coverage year. Then check out plans available to your location. You can also check to see if you qualify for premium subsidies.
You can save on premiums by checking if you qualify for premium tax credits or cost-sharing reductions (subsidies). If you have had a change in income level, or if you expect that it will happen soon - check your coverages. Your premium tax credit qualification may be affected.
Your premium may go up or down, usually in the same direction as the pay change. You may qualify for more federal assistance premium tax credit or you may lose the monetary help completely if you earn over the 400% of the poverty line.
ACA insurance is affordable for everyone. Because of premium subsidies, you can get bronze and silver plans with $0 premiums. You should first confirm the plan that suits your situation by talking to a Texas-licensed health insurance agent. If you actually cannot afford ACA insurance, talk to an insurance agent to find out what you can do to get health coverage.
Quite frequently ACA insurance is not the best solution for the needs of the insured and a licensed insurance professional can suggest how to save you money while getting you the coverage that fits your specific needs.
If you are unemployed and have no source of income, the ACA may be able to help you find a low-cost health insurance plan depending on your income and household size. The plan you are eligible for and how much assistance you will get paying for it is determined by your household size and income, not your employment status. The problem is that estimating your income when unemployed is difficult. Despite this, you may be able to estimate based on all present and anticipated sources of revenue for the year. You can include any of the following types of income in your application:
If your income is below the Federal Poverty Level (FPL), an insurance professional may be able to guide you towards other medical coverage through government programs.
There is no means of paying ACA insurance upfront. You pay your ACA premiums every month before the due date or the end of your grace period. Hence, you do not save by paying upfront.
ACA insurance provides premium discounts in the form of premium tax credits and cost-sharing reductions. You may be eligible for premium tax credits if your estimated income for the year is between 100% and 400% of the federal poverty level (FPL).
Generally, you should speak to a licensed insurance agent to help you save costs on ACA insurance. They know the current local market, the best plan options currency being offered, and the corresponding prices. The licensed agent can help you figure out what works best for your needs and give you the choice of quotes to consider.
The insurance agent's purpose is to understand your needs and to give you options for how these needs can be met in the most affordable fashion.