Texas Health Insurance

Health insurance in Texas

● Texas uses the federally managed marketplace HealthCare.gov.

● The open enrollment for 2021 health plans is from 1 November to 15 December 2020. Texas residents with qualifying events can sign up outside that window.

● Enrollment grew by 2020, with more than 1.1 million people selecting plans during open enrollment.

● Short-term health plans are available in Texas with initial plan terms of up to 364 days (the state does not comply with federal rules).

● Ten insurers will offer plans in the Texas exchange for 2021, up from eight in 2020.

● Texas continues to refuse to accept the ACA's Medicaid expansion.

This page is dedicated to helping consumers quickly find health insurance resources in the state of Texas. Here you will find information about the many types of health insurance coverage available. You can find the basics of the Texas health insurance marketplace and the next open enrollment period; a brief overview of Medicaid expansion in Texas; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of Texas health insurance resources for residents.

The Texas Health Insurance marketplaceplace

Texas uses the federally operated (exchange) marketplace HealthCare.gov has one of the highest trade registrations in the country. Only Florida and California have a higher exchange membership.

The insurance marketplace offers health insurance plans for individuals and families who need to purchase their own health insurance. This includes precosed retirees (who will turn to Medicare when they're 65), self-employed residents, and people employed in a small business that doesn't offer employer-sponsored health benefits.

marketplace use is optional; Individuals and families in Texas can choose instead to purchase coverage directly from a health insurance company. But the marketplace is the only place where Texas residents can benefit from financial assistance benefits based on their family income. This includes premium grants (which offset the monthly cost of coverage) and cost-sharing reductions (which reduce out-of-pocket medical expenses - deductibles, coinsurance, and copays).

Eight health insurance companies offer health plans in the Texas exchange in 2020. This will grow to ten in 2021, with the addition of Friday Health Plans and Scott & White Health Plan, both of which have made company decision to start offering coverage in the Texas marketplace. The proposed rate changes for 2021 range from a slight decrease to a double-digit increase, depending on the insurance company.

Texas open enrollment period and dates

Open enrollment for 2021 health plans is from November 1, 2020 to December 15, 2020. This annual window allows new applicants to apply for health coverage and gives existing enrollees the opportunity to renew or change their coverage for next year and update their financial information with the exchange, so that their financial assistance for next year is accurate.

Outside of the open enrollment period, Texas residents can only enroll in individual medical health coverage if they experience a qualifying event. If a person submits an application or requests a plan change outside the open enrollment window, health insurance companies require proof of the qualifying event, regardless of whether the application is submitted on the stock exchange or directly through the insurance company.

Texas enrollment in qualified health plans

During the open enrollment period for 2020 coverage, 1,116,293 Texas residents enrolled in private individual marketplace plans in the Texas health insurance marketplace. Texas was one of the few states HealthCare.gov where enrollment grew in 2020.

Medicaid expansion in Texas

The ACA would expand Medicaid to cover all legal residents in Texas with incomes of up to 138 percent of the federal poverty level, but a Supreme Court ruling in 2012 allowed states to forgo Medicaid expansion. Texas remains among the declining minority of states that have continued to reject Medicaid expansion.

Because of the state's refusal to expand Medicaid, 761,000 Texans are in the coverage gap, with no access to financial assistance with their health insurance. That's much more than any other state that hasn't expanded Medicaid -- the next highest is Florida, with about 391,000 people.

Between 2013 and March 2017, Texas' current Medicaid/CHIP program saw an increase of about 13 percent, despite the state's very strict eligibility guidelines. By 2019, enrollment had actually fallen below where it had been in 2013. But as of May 2020, total enrollment in Texas Medicaid/CHIP was up to 4% higher than in 2013. The COVID pandemic has led medicaid enrollment higher across the country, due to widespread job losses and reduced income. This is also true in states like Texas that have not expanded Medicaid under the ACA.

Medicaid eligibility rules in Texas are particularly strict: Non-disabled adults without dependent children are not eligible regardless of income, and parents with dependent children are eligible only if their family income does not exceed 15% of poverty (less than about $3,200 per year for a family of three).

Short-term health insurance in Texas

Texas regulations on the definition and duration of short-term health plans are in line with new short-term federal rules. As a result, plans in Texas short-term health insurance can have initial terms of up to 364 days and can be renewed for a total duration of 36 months.

Obamacare in Texas

In 2010, U.S. Senators John Cornyn of Texas and Kay Hutchison, Republicans, both voted no to the ACA. In the House, 20 Republican representatives from Texas voted no, while 12 Democrats voted yes. Ted Cruz has since replaced Hutchison in the Senate, and is one of the ACA's most outspoken opponents in the country.

Former Texas Governor Rick Perry was also staunchly opposed to the ACA and had a state legislature with a strong Republican majority. The state chose to let HHS perform the exchange, refused to expand Medicaid, and even worked to make it harder for navigators to do their jobs in Texas.

In January 2015, Greg Abbott was governor of Texas. He expressed his opposition to the expansion of the current Medicaid system. However, he would like Texas to use federal Medicaid funds in the form of global grants.

Did the ACA help the Texans?

Prior to the implementation of the ACA, Texas had the highest uninsured rate in the country in 2013 (22.1%). It has since fallen, but Texas still has the highest uninsured rate in 2018, at 17.7%.

Texas leaders have been vocally opposed to the ACA, and the state has so far refused to expand Medicaid, so a cornerstone of the law's ability to reduce the uninsured rate is not available in Texas.

But more than a million Texans are enrolled in private health plans through the exchange, and 92% of them receive premium subsidies that average $468 a month and make their monthly health insurance premiums more affordable. And 60% of them are receiving cost-sharing reductions, which make their out-of-pocket health care expenses (deductible, copays, coinsurance) cheaper.

Medicare coverage and enrollment in Texas

There were nearly 4.3 million Texas residents enrolled in Medicare as of August 2020. That's about 14 percent of the state's population, compared with nearly 19 percent of the U.S. population enrolled in Medicare. Most Medicare beneficiaries of the state are eligible for coverage because of their age (at least 65), but 15% are under 65 and are eligible for Medicare due to a disability.

More than 2.4 million Texas residents are enrolled in Original Medicare (Part A, Hospital coverage and Part B, outpatient coverage), while more than 1.8 million are enrolled in private Medicare advantage plans. The number of Medicare Advantage members has grown faster than the overall growth in Medicare enrollment (the number of Texas Medicare beneficiaries enrolled in Original Medicare has declined over the past year, despite the fact that total Medicare enrollment has grown by more than 84,000 people).

Health insurance resources in Texas

● Texas Department of Insurance - Oversees, regulates, and licenses health insurance companies that provide coverage in the state, as well as agents and brokers who sell policies.

● Texas Health Information, Counseling and Advocacy Program - A resource for Medicare beneficiaries and their caregivers; can answer questions about a wide range of Medicare issues.

● Change Happens Healthcare Navigators - This is the federally funded Navigator organization in Texas (the corporate office is located in Houston, but navigators can provide assistance, answer questions, and help with enrollment across the state).

● Medicare Rights Center - A national resource for Medicare beneficiaries.

State legislation on health reform

Texas has legislative sessions only in odd years. This resource, published by the Texas Department of Insurance, details the health reform laws that were enacted in Texas in the 2017 legislative session.

Several major health reform laws were enacted in Texas in 2017 and 2019. They include:

● SB1742, issued in 2019, requires health plan providers' directories to clarify whether even specialists practicing at networked facilities are networked. In addition, the legislation imposes new rules on prior authorisation, including a readily available list of services subject to prior authorisation requirements and information on the insurer's total volume of prior authorisation and refusal requirements.

● SB1264 protects Texans enrolled in state-regulated health plans (i.e. plans that are not self-insured) from surprise balance billing. It applies to medical services received as of 1 January 2020 and essentially requires the insurer and off-network provider to take care of the payment methods without involving the patient. Surprise billing refers to situations where emergency care is provided in an off-network facility or when a patient is in a networked facility but is treated - often unkk knowingly - by a medical service provider that is not part of the patient's insurance network. Instead of billing the patient amounts higher than normal cost-sharing requirements, the out-of-network provider must use a state-regulated mediation/arbitration process to process a payment amount with the patient's insurer.

● SB1037, promulgated in 2019, guarantees that surprise balance invoices sent to receipts will not appear in the person's credit report.

● HB214, enacted in 2017, prohibits elective abortion coverage on all major medical plans (including plans sold through the exchange) in Texas. Twenty-five states had already enacted similar legislation.

● SB1406, enacted in 2017, authorized the state to submit a 1332 waiver proposal to the federal government, seeking permission to waive actuarial value requirements currently applicable in the small-group health insurance marketplace. The idea is to allow small group plans to have a wider range of actuarial values, instead of having to conform to the current bronze, silver, gold or platinum categories. The legislation was signed into law in May 2017, but the state never submitted a 1332 waiver proposal. The Texas Department of Insurance released a brief in early 2018 detailing several other potential 1332 waiver proposals that could be used to stabilize the individual marketplace, but the related legislation was not enacted in 2019.