How to Get the Silver 87 or 94 Health Plans in Texas
When we run quotes and these plans come up, our eyes light up. We get a little giddy which is hard to do about health insurance.
The Silver 87 and 94 plans are basically Platinum level plans we can get at the price of the silver plan.
Super rich as we'll see below and it's all based on income.
Here's the issue...50% of people who enroll themselves make mistakes on the income piece and some are missing out on the silver 87 or 94!
We'll go through all of it below but first, our credentials:
This is what we'll cover:
- What are the silver 87 and 94 plans in Texas
- How do I get the silver 87 and 94 plans
- What's the income needed for silver 87 and 94
- Why silver 87 or 94 is the best Texas health plan on exchange
- How to quote and enroll in the Texas silver 87 or 94
Let's get started!
What are the silver 87 and 94 plans in Texas
The entire individual family market revolves around income since 2014.
Our income estimate for this year (AGI on the 1040 tax form; next April's filing) drives two key aspects:
- Subsidies or tax credits that bring down the cost of our monthly premium
- Richer benefits at the silver level
We've discussed how to get the most subsidy already but let's turn our attention to the enhanced silver plans.
They go by different names including enhanced silver or silver cost sharing reduction. Either way, we have potential silver levels depending on income:
- Silver 70 - the standard silver; mid-level deductible, copays, high max out of pocket
- Silver 73 - 3% richer than the standard silver; not terribly different
- Silver 87 - almost a platinum level plan, low deductible, rich copays, much lower max
- Silver 94 - 4% richer than a platinum plan, no deductible, richest copays, lowest max
These richer versions of silver make the silver plan the most popular plan by far on the exchange.
By the way, to get these richer silver plans (and the subsidies), we have to enroll on-exchange and we'll show you how to do that below.
A few notes before we get into the key questions around these plans.
If your income qualifies you, the silver 87 and 94 will be available from EVERY carrier on the exchange in Texas.
Once you know this is an option, you can then check carriers, networks, and rates to decide which way to go.
The benefits will be standardized which means they will be the same across carriers and networks.
So, it then becomes a question of doctors that work with a given plan or carrier and rates!
We have big guides on comparing Texas carriers or how to compare Texas exchange networks.
Another source of confusion...since 2014, it's all one standardized marketplace and it goes by many names: ACA, Obamacare, on-exchange.
Same thing! Don't get mired down in terminology...on-exchange quotes will show you the silver 87 and 94 if you're eligible.
Speaking of which.
How do I get the silver 87 and 94 plans
The version or "flavor" of silver plan is solely based on income.
- Income is our best estimate for this year's AGI on the 1040 tax form; next April's filing.
- Their definition of household is everyone that files together on one 1040 tax form, even if not enrolling.
This gets confusing fast so reach out to us for free assistance:
When you enter this information in the free quote system below, you'll notice that it may show cost sharing at 87 or 94.
More importantly, you'll notice the deductible crashes through the floor at the silver level!
If something doesn't match the chart above and you think it should, reach out to us.
With on-exchange enrollment, there are also certain times we have to enroll:
- Open enrollment - Nov 1st - Jan 15th each year
- Special enrollment periods - losses of coverage, moves, big household changes, etc.
Learn more about when you can change Texas exchange plans or what if you missed open enrollment.
Again, we're happy to help with your situation.
One note...if you're eligible for the silver 94, you might also be able to enroll anytime during the year as there's a special enrollment period around that income level that we can use year around!
More on that special enrollment period based 150% income.
Speaking of income...
What's the income needed for silver 87 and 94
This is it people.
Okay, first let's re-define household. It's everyone that files on a 1040 tax form together. This year's situation (not this year's filing).
For example, if I'm enrolling for 2024, I would estimate my AGI on the April 2025 1040 tax form and filing.
It's then all about income and there's the general chart:
A few notes.
It's usually your gross income if W2 or your net business income if self-employed (see self-employed health coverage in Texas).
We have a deep dive into the income chart for Texas exchange plans but a few notes.
You can see the range for the silver 94 is pretty tight. More importantly, below that (100%), you lose not only the richer silver benefits but also the subsidy.
That's the Medicaid range IF you meet other requirements (usually pregnant or disabled).
So...
- Silver 94 - 100% - 150% of the base level on the above chart
- Silver 87 - 151% - 200% of the base level
There's also the silver 73 but that's not as impressive.
What if we're right on the line between 73 and 87 for example?
Keep in mind that it's an estimate for the full year and most people have a lot of variability in their income estimate.
Think self-employed who may not know what their net income is till they file taxes!
There are above-the-line deductions that they may not be aware of.
Reach out to us and let's really scrub your income estimate to make sure you're getting everything that's due to you.
It's basically how we spend half our time these days!
If you are eligible for the silver 87 or 94, look no further!
Why silver 87 or 94 is the best Texas health plan on exchange
We commonly tell people this.
If you're eligible for the silver 87 or 94, look no further!
There's no real reason to go richer than the silver plan since they're basically platinum plans.
Platinum is 90...which basically means it's expected to pay 90% of the costs for the average person in a given year.
Silver 87 is 3% less rich and silver 94 is 4% richer.
For the same price of the silver! After subsidy since being eligible for either plan means you're getting a pretty big subsidy by default.
You could go to the bronze level plan if there's any savings there or you just want major medical insurance but any health issues that crop up...even an x-ray from a fall or something will quickly make up the savings in premium.
If something bigger happens, you're talking about $1000's out-of-pocket difference!
That doesn't make sense if you're eligible for the silver 87 or 94. We're happy to compare these options for you.
You can also run the quotes right now!
How to quote and enroll in the Texas silver 87 or 94
We make this free, fast, and easy here:
Remember, income estimate is this year's income estimate for the AGI on the 1040 tax form; next April's filing.
Household is everyone that files together even if not enrolling.
We really want to make sure people get the best option so reach out to us. There's zero cost for our assistance.
Establishing the silver 87 or 94 PLUS the subsidy is the first step.
We still need to pick a carrier and networks!
How can we help?