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Texas Health Insurance - Affordable Care Act- ObamaCare


Enrollment begins for the Affordable Care Act, also known as ObamaCare, on Tuesday October 1st 2013. Because of the new law all Americans and legal residents are required to have a health insurance policy that meets minimum federal Affordable Care Act (ACA) standards or pay a fine to the Internal Revenue Service.

The ACA law also forbids insurance companies from excluding anyone for purchasing a plan regardless of prior health history or current pre-existing conditions. Regardless of condition, currently pregnant, receiving treatment for cancer, high blood pressure or upcoming surgery the health insurance companies are required to sell you a policy without waiting periods.

The law continues to read that all policies must meet minimum design standards and be broken into 4 tiers, Platinum, Gold, Silver and Bronze with the Silver series of plans being the benchmark standard. The major difference in the 4 tiers is out of pocket levels for things like deductibles and co-pays and the Platinum level is considered the highest tier available. Regardless of tier level these new plans far and exceed current pre 2014 plan designs.

Your only opportunity to sign up for or change a plan is during very defined Open Enrollment Periods generally between October 15th and December 7th each year however the first year enrollment runs from October 1st 2013 to March 31st 2014. You miss that time you miss out on getting any major medical coverage as the entire health insurance market will be completely closed except in very narrow Special Election Periods. Special Elections Periods or SEP’s as we call them are granted for situations like changing your residence, getting a divorce or married, having a newborn or losing your current job or coverage by no fault of your own, otherwise you are flat locked out of the market.

These plans cover more benefits and are guaranteed issue so obviously premiums may be higher than before 2014 but most Texans will qualify for federal advanced premium tax credits also known as Subsidies. These subsidies will allow most Texans to find coverage at an affordable rate but you must know how to both find them and navigate the process. This new process is not easy and we highly recommend using an experienced agent or broker that has trained, tested and become certified to market these highly complicated plans.

Well, like we said above most Texans will receive federal subsidies to pay their premiums but there is also an additional form of assistance called Cost Sharing Reduction Subsidies (CSR). These CSR are designated for consumers making less than 250% of the federal poverty line and will help pay deductibles, co-pays and other expenses related to out of pocket cost allowing more middle income Texans to see even less money out of their already tight monthly budget.

The Affordable Care Act states that Medicaid is available to those families under 100% of the federal poverty line and you should check with the State of Texas to confirm eligibility. Bottom line anyone above 100% of the
federal poverty line is eligible for ACA subsidies. In order to apply for Medicaid you will need to check with the State of Texas to begin the application process.

Our job and mission is exactly the same as it has been for the last 21 years, find our clients the best coverage for the lowest monthly price. Nothing has changed, it still cost nothing to work with a broker as we are paid by the insurance companies to enroll and service our clients. We will assist in applying for your federal subsidy and then searching out the best plan for you and your family also assisting in the application process to lock the health plan down for 2014. We also will always be here to assist in any servicing matters that may arise throughout the year to insure a pleasurable insurance buying experience.

Brokers and agents will also assist those higher income families and individuals that exceed 400% of the federal poverty line in finding the lowest cost coverage for their family.

Bottom line with all the choices, up to 102 in one geographical location of Texas alone you should work with a Texas Health Insurance Broker.

 The time is now, the clock is ticking, call us today to find the health insurance plan for your family. It’s the law to be covered, let us handle the complicated paperwork.



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