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Texas Health Insurance

The Affordable Care Act means Texans will have more options to access health insurance in 2014, although it has been met with some resistance from state government. According to the Kaiser Family Foundation, in 2012, Gov. Rick Perry announced Texas would not form its own state exchange, and the state returned $900,000 of a $1 million exchange-planning grant to the government.

However, Texans are still free to use the federal health insurance marketplace at HealthCare.gov. According to the U.S. Department of Health and Human Services, about 295,000 Texans applied for private plans through the federal exchange as of March 2014. Nearly 95,000 more Texans were deemed eligible for Medicaid or Children’s Health Insurance Program benefits.

What is the federal health insurance marketplace?

Texas residents can visit HealthCare.gov to sign up with the federal marketplace during open enrollment. The process requires setting up an account and answering a few simple questions about family members and income. You can estimate income or electronically submit a recent tax return. After the first part of the process is completed, you’ll be shown different plans from private insurers.

People with low to moderate income might find they qualify for Medicaid or CHIP. Applicants can also find out if their families qualify for subsidies, which come in the form of tax credits, to offset premium costs.

Do you qualify for a subsidy in Texas?

Under the ACA, people with incomes between 100 and 400 percent of the 2013 federal poverty level qualify for tax credits (subsidies) to offset their premiums if they do not qualify for any other form of assistance or an employer-based medical plan.

The income range to qualify for a subsidy is between $23,550 and $94,200 for a family of four and between $11,490 and $45,960 for an individual.

Children from families with incomes up to $1,925 per month may qualify for the Texas Children’s Health Plan, which works through the federal Children’s Health Insurance Program.

What is the coverage gap?

The designers of the ACA assumed states would expand Medicaid along with the implementation of the new marketplace; therefore, people with incomes below the poverty level are not eligible for subsidies.

However, 21 states including Texas did not expand Medicaid coverage. Medicaid is very limited in Texas for nondisabled adults, and this is particularly true for those without children. This issue creates a coverage gap for people who earn too much money to qualify for Medicaid and too little to qualify for an income subsidy.

Major health insurance companies in Texas with marketplace plans

You are likely to find exchange plans from some of these companies in most areas, but you may only see offerings from some smaller insurers in certain regions:

• Blue Cross and Blue Shield of Texas
• Aetna
• Humana Insurance Company
• Cigna Health and Life Insurance Company
• Molina Healthcare of Texas
• Ambetter from Superior Health Plans
• Scott & White Health Plan
• Sendero Health Plan
• CommunityFirst
• Community Health Choice
• Firstcare Health Plans

Texas health and coverage statistics

Texas population (2013): 26,448,193
Population 65 and older (2012): 10.9 percent
Life expectancy (2010): 78.5 years
Number of Medicaid beneficiaries (2012): 3,891,200
Number of Medicare beneficiaries (2012): 2,626,300
Estimated number of uninsured residents (2012): 6,252,600

Overall state health ranking: 36

Sources: Kaiser Family Foundation, U.S. Census Bureau, America’s Health Rankings 2014 report.