Texas Health Insurance Exchange Guide

Starting in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state health insurance exchanges. All states have three options for setting up a state health insurance exchange for 2014:

1. Build a State-Based Exchange,
2. Enter into a State-Federal Partnership Exchange, or
3. Default to a Federally-Facilitated Exchange

Texas will default to a federally-facilitated health insurance exchange. The exchange will open in October 2013, for coverage starting January 1, 2014.

Texas Health Insurance Exchange - History

After the Affordable Care Act passed in 2010, the Texas Department of Insurance and the Health and Human Services Commission partnered to explore exchange implementation plans. Using federal grant funding they identified subcontractors to assist with the exchange planning process, to collect stakeholder feedback, and to investigate the state’s policy options. Texas held a public exchange planning symposium and solicited public comments in early 2011. Texas received a Federal Exchange Planning grant of $1 million in 2010, however the state has since returned $900,000 of this grant to the federal government. 

On July 9, 2012, Governor Rick Perry announced that Texas would default to a federally-facilitated health insurance exchange.

Texas Health Insurance Exchange - What is It?

The Texas health insurance exchange will be operated as a federally-run health insurance exchange, through the Health Insurance Marketplace ("Marketplace").  

According to healthcare.gov, starting in October 2013 Texans will be able to access information about all the plans available through the Marketplace. The SHOP Exchange will also be available to small businesses. Coverage for plans purchased through the Marketplace starts in January 2014.

Texas has the largest proportion of citizens in the nation without health care, approximately 25%, or 6.2 million people.

Texas Health Insurance Exchange - How Much Will Plans Cost?

According to the Center for Medicare and Medicaid Services (CMS), prices for policies sold in the Marketplace have not been established yet.  Under ACA insurers won’t be able to charge more based on gender or health status, and there will be limits to how much premiums can vary based on age.

In addition, consumers with income below 400% of the Federal Poverty Level, who are buying insurance for themselves or their family, will get tax credits that cover a significant part of their costs.  CMS estimates that a family earning twice the federal poverty level would pay less than $3,000 for their coverage for a year – compared to more than $11,000 without health insurance coverage through the Marketplace.

Texas Health Insurance Exchange - How to Apply for Coverage

According to CMS, starting October 1, 2013 consumers will be able to file a Marketplace application online, by phone through a toll-free call center, by mail or in person (with accommodations for people with disabilities). 

The Marketplace will automatically tell consumers if they qualify for discounts or qualify to participate in state programs based on their income.

Once the consumer is approved, they can choose the health plan that’s right for them through the online plan comparison tool. The consumer will get an insurance card after they are enrolled in a health plan. When the consumer enrolls in a plan, the tax credit will be sent to the health plan (if qualified). If a consumer is potentially eligible for Medicaid/CHIP, the information is sent to the Medicaid/CHIP state agency.

Details on the Marketplace such as what it will look like, and details on what plans will be available, are still limited.

More information for consumers can be found at HealthCare.gov.