Things you need to know about buying health insurance in Texas

ACA-compliant coverage

ACA compliant coverage refers to health insurance plans that offer benefits for a broad range of healthcare services that meet the requirements established by the Affordable Care Act, also known as Obamacare.

There are several things this means, but you as a health insurance consumer should know what it means for you and why it is so important,

1. Plans are guaranteed issue during Open Enrollment Period (OEP). This means that you as a consumer can’t be denied coverage because of any pre-existing condition. You may also be eligible to apply for ACA compliant coverage outside of the open enrollment period in case of any Qualifying Life Event (QLE)
2. Annual and Lifetime Limits: Under the Affordable Care Act, the insurance company can’t cap annual dollar limit on most the plan benefits
3. Ten essential health coverages:
• • Ambulatory patient services
• • Emergency services
• • Hospitalization
• • Pregnancy, maternity, and newborn care
• • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• • Prescription drugs
• • Rehabilitative and Habilitation Services
• • Laboratory services
• • Preventive and wellness services
• • Pediatric services, including oral and vision care (doesn’t include adult dental and vision)

Once you know that you are eligible to apply for ACA compliant health plan. Search for plans that best suited to your health condition and financial ability to pay for the plan over the entire period of coverage.

Who you can apply for?

You can apply for yourself or anyone who lives with you.

Financial Assistance

Federal financial assistance/ subsidy are available for people within certain income bracket during open enrollment period November 1- December 15, which can lower your monthly premium. Additional cost sharing reduction subsidy is also available to you if buying a “Silver plan” to further lower the cost of deductibles, coinsurance and copays. Learn if you qualify for financial assistance.

Shop around

Don’t just renew your old plan but Shop around for any alternative coverage that may be available each year that best suites to your current health condition. New carriers may be available offering better value for your money. Take the time to compare your existing plan with new offerings to be sure that you are not paying more than you should for similar coverage, deduction, out-of-pocket expenses etc. Health insurance policies, if not chosen correctly can have a major impact on both your health and financial life.

Health Insurance companies available in Texas

• • Ambetter from Superior HealthPlan
• • Blue Cross and Blue Shield of Texas
• • Friday Health Plans
• • Molina Marketplace
• • Oscar
• • Scott and White Health Plan

Metal Levels/ Plan Type

• • Bronze
• • Expanded Bronze
• • Silver
• • Gold
• • Catastrophic

Networks to choose from

• • Health Maintenance Organization (HMO): A type of health insurance plan that usually limits to a local network of doctors who work for or contracted with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.
• • Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency). EPO is usually more pocket-friendly than a PPO plan.