Your first ACA premium in Texas can be paid online, directly through your Marketplace account.
Once your new insurance company processes you as a client, you start making payments directly to it. The most common way to make a monthly premium payment to an ACA insurer in Texas is via a bank draft. This is usually done on the insurer's website, after logging in to a member portal. The draft can be done as a one-time payment or a monthly recurring transaction.
If you need to pay for a group health insurance plan through an employer or an association, the payment is usually deducted directly from your pay.
Other possible ways to pay your premium depend on the insurer but usually include:
Ensure you pay your health insurance monthly premiums on time. If you do not, your coverage may be terminated, and there may be other consequences.
Who pays for ACA insurance in Texas depends on the plan that you get. If it is a personal plan, you pay your monthly premiums yourself. If it is a family/household account, it is the contact person of the household that is legally supposed to pay for their ACA insurance . If it is a plan from your employer, you and your employer share the responsibility of payment. An employer typically covers a percentage of your premium while you cover the rest.
Note: Texas employers are legally required to offer a Silver ACA plan that meets the federal affordability threshold. As of 2022, this meant that if the employer offered a group health insurance, it had to offer at least one plan where it's premium costs was no more than 9.61% of employee's household income.
You can either pay your ACA insurance online or through any payment method recommended by your insurance provider. Premiums for ACA plans are paid every month.
No, you cannot finance the cost of ACA insurance. Financing insurance is mostly done with property insurance and life insurance in rare situations.
No. Premium financing is usually only available for property and life insurance. Premium financing is borrowing funds from a person or entity with interest, to pay your insurance premiums.
Premiums for ACA insurance are paid every month in order to keep the policy active.
ACA insurance is paid monthly.
ACA compliant insurance does not offer an option to make one annual payment (unlike alternative Texas health plans, which may provide a discount for paying in full)
No. Your new ACA insurance plan cannot cover old bills. Every bill to be settled by your old health plan has to be covered by your old plan. It cannot be transferred to your new plan. It does not matter that your plan was canceled or that your bills are outdated or overdue; your former insurer/insurance plan will cover it. The prior policy's benefits continue to apply to the care you received while it was in effect. You could potentially be compensated if you received medical treatment when covered by previous insurance but did not make a claim.
If you have received a bill for a procedure that was supposed to be covered by the now-expired policy, contact that previous insurer. The insurer will process your bill just as they did when the policy was active.
Alternatively, if you had coverage from multiple sources that overlapped in time (duplicating coverage), you would need to find out which policy pays first. Contact the insurer or a licensed Texas insurance agent to go over your questions about ACA insurance.
It depends on whether the doctor is an in-network doctor or an out-of-network doctor. If the doctor is within your provider's network, you should make all payments to your insurance provider. If the doctor is outside your provider's network, pay the doctor and ask your insurance provider to reimburse you. The reimbursement will be subject to the terms of your policy.
Copay is a small flat fee that you pay at the time of service, usually prior to being seen at the medical facility.
Deductible is the amount that you need to spend during the year out-of-pocket before the insurer starts providing coverage according to the policy. Payments you make for most covered services are counted towards your deductible amount. Such payments can be made to medical providers, pharmacies, and for other medical necessities.
Once you have met the deductible, you may start paying coinsurance, according to the metal tier type of your ACA plan.
Coinsurance is a percentage of medical costs that you are responsible for (according to the type of your ACA plan: Bronze, Silver, Gold, Platinum). Just like with the deductible, you must pay the percentage listed in your policy to the medical providers and facilities you visit. You may be asked to pay your coinsurance at the time of the visit or billed for it at a later date, usually via mail.
No. You do not pay taxes on ACA insurance. Actually, you can even get premium tax credits that can be applied towards the ACA insurance premiums, making your plan more affordable.
Yes, you can pay ACA insurance late in Texas, as long as the payment is made during the grace period. during the "grace period". A grace period is the "extra time" you have to pay to prevent your plan from being terminated.
Yes. ACA insurance has a grace period for you to pay your insurance premiums. The grace period for ACA health insurance in Texas may be 30 days or 90 days.
A grace period is a brief period — either 30 or 90 days — following the due date of your monthly health insurance payment. If you purchase your plan from the Marketplace, receive premium subsidies, and have paid up to a month's premium, your grace period is 90 days. If not, your grace period is 30 days.
If you have not paid your premium on time, you have until the end of the grace period to do so to keep your health insurance coverage.
No. Once the grace period for your ACA insurance is over, your plan lapses/terminates. You cannot get a new plan until the next open enrollment period because if you lose your health coverage due to non-payment of premiums, you do not qualify for a special enrollment period. However, you may be able to get another ACA plan during a special enrollment period if you experienced another life-changing event other than "losing your health coverage."
Alternatively, you can get a short-term health insurance plan or any non-ACA-compliant plan to carry you over until the next open enrollment period.
There are some options you have if you cannot pay for your ACA insurance. One option is to cancel your ACA insurance and get a low-cost, short-term insurance plan to cover you until the end of the year. You could also check if you qualify for the hardship exemption to get an ACA catastrophic plan.
Overall, it is best to discuss your options, based on your circumstances, with a licensed insurance agent in Texas. An agent can provide you with the best guidance on what you should do.
No. Your ACA insurance does not lapse because you miss a payment. An ACA plan is said to lapse when it terminates because of non-payment of premium beyond the grace period. Hence, if you miss a payment but still fall within the grace period, you can still pay and have your plan's coverage.