Learn more about your ACA (Affordable Care Act) Health Insurance options.
If you need group coverage or individual dental or life insurance, please feel free to contact us. Unfortunately, due to ACA regulation changes which have taken place to Individual Health Insurance plans and Agents over the past few years, it is no longer feasible for this agency to support new coverage placement for our customers. If you currently have coverage placed by us, we will continue to service those plans. If you need individual coverage, please go to www.healthcare.gov for further assistance.
If you live in Texas and either buy your own health insurance or are currently uninsured, this guide is for you. It will help you understand some of the rules and requirements under the Affordable Care Act (ACA)
Frequently Asked Questions about Obamacare
Do I have to buy health insurance?
Yes. The ACA penalty, also known as the Individual Mandate, requires U.S. citizens under the age of 65 to enroll in a health insurance plan or pay a fine. For 2016, not carrying insurance will cost the greater of: $695 per adult plus $347.50 per child (up to $2,085 per family) or 2.5 percent of your family’s income. The total payment amount is capped at the cost of the national average annual premium for a bronze level health plan . The fee will increase each year with inflation.
What are my options for buying an Obamacare health plan?
Texas offers health plans from multiple health insurance carriers in 5 coverage levels, commonly called metal tiers. Platinum is the most expensive plan type, but offers the best cost-sharing benefits, covering 90 percent of health expenses incurred. On the other hand, Bronze is the least expensive plan type, but only covers 60 percent of incurred health expenses.
Am I eligible for insurance?
You are eligible under the ACA if you are under the age of 65 and also a U.S. citizen, a U.S. national or a lawfully present immigrant living in the U.S. Illegal immigrants and incarcerated individuals are not eligible to purchase coverage. You cannot be eligible for federal coverage programs such as Medicare, Medicaid, or CHIP. You may purchase insurance, even if you are eligible for employer-sponsored coverage, however, you will not be eligible for subsidies (tax credits to help you pay for insurance) unless your employer’s coverage amounts to more than 9.5 percent of your annual income.
Who is exempt from insurance?
You may qualify for an exemption from the ACA penalty if you are:
Can I buy ACA coverage for my children and not for myself?
Yes. You can choose to insure your children through the marketplace without including yourself in the coverage. However, you and your spouse will be subject to the tax penalty for remaining uncovered.
I had a stroke last year, can I still get covered?
Under ACA, insurers are no longer allowed to deny coverage based on pre-existing medical conditions.
Do I have to be on the same plan as my spouse?
No. The Affordable Care Act does not require that spouses be on the same plan. However, if you are looking to qualify for a subsidy (tax credits to help you pay for your insurance), your total household income will be considered. That will include your spouse’s income, whether or not you are on the same plan.
Do I Have to Buy Health Insurance?
It’s important to sign-up for health insurance. You may have heard that everyone in Texas must have health insurance or pay a penalty.
It is recommended you purchase health insurance of some kind, even if it is only Catastrophic or Temporary coverage. That's because unexpected medical expenses can easily bankrupt anyone who is uninsured.
Do I Qualify for a Tax Break on Health Insurance?
If you qualify, the subsidy can be used to reduce the cost of your monthly premium or can be taken as an annual tax credit. If you qualify for a tax credit or subsidy, the amount automatically be shown in the online quotes be subtracted from your monthly premium
Please Note: All of our Texas clients are billed directly by the reputable U.S. companies we represent. This agency NEVER bills or collects any premiums from our customers.