The numbers of Texans that are finding found money through the exchange keeps growing:
https://texas2036.org/posts/texas-crosses-threshold-of-3-million-covered-by-aca/
We'll explain why below but also note this is only 10% of the population!
Look...the benefits and networks are standardized for on and off exchange now.
Our credentials are here:
But how do we compare all the plans available once we figured out our subsidy (more guidance on the subsidy piece)?
Below is the rough sketch that will handle about 80-90% of your questions but reach out to us with the remaining amount as there's zero cost for our assistance!
Let's cover the following:
Let's get started!
Texas decided to piggyback the existing Federal Exchange to save money which is smart.
The Exchange is just a means to process and apply the subsidy (subsidy). Point.
Your actual health insurance will still be with the carrier directly. You pay the carrier. You get coverage from the carrier.
All the Exchange does is reduce the amount you pay monthly based on income. That's it!
So why even go off exchange? Some people will definitely not qualify for a subsidy because income is too high. They don't look at assets for eligibility as an aside.
For these people, enrolling direct with the carrier might skip the Exchange step but that's about it.
Let's assume you'll qualify for a subsidy (you would be surprised how high income can do and do so). That's really the first question and step and our quoting tool takes care of all of it. For free!
We have a whole guide on getting the most Texas health exchange subsidy but a little intro since it's so important.
A few key notes:
Those are the broad strokes but check out the guide above.
How much are we talking and what's the limit?
Age really affects the amount we'll get as health insurance gets more expensive with age and so the subsidies go up as well.
Below a certain amount, the system will offer medicaid IF you meet other qualifications. Above that levels we start to get the most subsidy on a sliding scale (decreases as income goes up).
The easiest way to see your subsidy estimate is to run a quote here and make sure to include your full household even if not enrolling (everyone that files together on a 1040 tax form).
We'll guide you through this process at no cost. Reach out to help@texasplans.com or by chat here.
Okay...that's off the table. Let's start to tackle the plans now.
If our income falls within certain ranges, we can qualify for much richer versions of the Silver plan for the standard silver rate. Check out the chart we made for you!
Total quote system will automatically reflect this when you enter your income.
There are 4 levels:
Look, if you're offered the 87 or 94, that's a slam dunk. They're ridiculously rich and the subsidy will also be high since it's all based on income.
You could go down to a Bronze plan to get lowest price (sometimes zero) but if anything healthwise comes up, the silver 87 or 94 will more than pay for itself.
Don't fight tide on this one:
With just your date of birth, zip code, and best estimate for this year's income, we can run the quotes for you and analyze everything at help@texasplans.com or pick a time to chat here.
Alright...whether we're eligible for the enhanced silver plans or not, we next need to look at network.
This is the second biggest deciding factor.
What network do we feel comfortable with and that partially drives us to certain carriers.
The big three:
People generally have a sense of preference here but let's explain how they differ in actual day-to-day terms.
HMO's are more structured:
EPO's offer more flexibility and control but at a cost:
POS tries to straddle the two!
HMO networks if you behave (follow HMO rules). Broader networks otherwise with higher costs.
When you run your quote, you can filter by network type on the left but you'll notice big price differences.
This choice of network partially narrows the carrier field. Let's now dig into the actual plans.
First, let's introduce the insurance lingo designed to mess everyone up!
Big walk through the Texas Exchange Metallic plans.
Okay...so far so good. Then the Texas exchange plans!
There are four basic levels that increase in cost:
This is where the rubber hits the road.
This means that a gold plan will be pretty comparable to another gold plan regardless of network or carrier.
That makes it a little easier.
So how do we compare what can be dozens of options?
Copays are NOT where the real cost is healthcare these days!
A simple surgery can runs 10's of 1000's pretty fast these days and we see bills at $250K all the time.
This is why you at least need some type of plan to protect from the big bill.
A few other key notes:
This can get confusing real fast. Lean on us! You saw the reviews.
There's zero cost for our assistance in comparing the Exchange plans.
Or run your quote here:
What if you just want the cheapest plan on the market for catastrophic coverage?
We mentioned above that the Silver 87 or 94 is hard to turn away from but what if we just want protection from the big bill.
We're actually big fans of this whether just a Bronze plan or even the HSA flavor of it.
This especially works if:
Why for these three?
If we compare the annual premium difference between the bronze and silver, it can be a lot of money!
Maybe 1000's per year.
That pays for a lot of copays and smaller bills. If the year goes smooth, we pocket that money.
That means they're going to treat the $100K bill pretty similarly.
If we get enough premium savings, it makes sense to go down the scale and "self-insure" the smaller stuff.
That's whole theory behind the HSA (Health Saving Account) plan.
That can mean a savings or 20-30% depending on your tax bracket!
We're happy to walk through how the HSA works. The account is not required...just an option if you're on an HSA qualified plan.
Reach out with any questions on find the best catastrophic Texas health insurance including HSA's.
One step removed is Short Term health plans available in Texas. These are not as robust as the Exchange plans but may be less expensive for people who just can't afford any of the plans including Bronze level plans.
You can quote those here and we're happy to help.
Speaking of quoting...
We make this fast, free, and secured here:
A few notes.
Make sure to enter your income estimate and size of household (even if not everyone is enrolling). It's this year's income estimate (AGI on next April's tax filing).
You can play with the income estimate up top when the quote comes up to see how it affects your options.
It can make a huge difference in your benefits!
Email us dates of birth, zip code, and best estimate for this year's income to get a second pair of eyes on hit.
There's no cost to use the quoting system or our assistance!
Email is help@texasplans.com or pick a time to chat here if your situation is more complicated (or not since health insurance is complicated already!).
We offer free online enrollment right through the quote if you find a plan you like. The subsidy will automatically be calculated and you'll get an invoice for the "net" premium.
Of course, as Texas health agents, we're here to help you throughout the year as well with changes, questions, and updates. Learn more what to expect from us as Texas health exchange agents.