The Affordable Care Act (ACA) offers important protections that assist those with preexisting conditions find affordable health coverage plans that cover more than just premiums; typically these plans also include copayments, coinsurance and deductibles – to determine this information in Texas you can use an online tool like eHealth’s.
Texas offers many people financial assistance through the Affordable Care Act marketplace to help pay their monthly premiums and lower out-of-pocket costs.
Premiums
Texas Affordable Care Act marketplace customers have enjoyed relatively stable premium costs over the last three years – which is welcome news given that insurance costs have skyrocketed more quickly than wages and inflation. Some insurers even provided rebates to individual market customers!
Premiums for silver plans have decreased by approximately 4% since 2020, while platinum plan deductibles have also seen some reduction. Deductibles represent the amount you must pay before health care costs will be covered under your plan.
This year, there has been an increase in insurers offering plans on the exchange. Now 88 Texas counties have at least one carrier offering plans, up from 79 last year. Also more affordable short-term plans can now be purchased during open enrollment periods running November 1 – December 15 and January 31 (special enrollment periods also exist if life changes arise such as relocation, job loss or having a baby).
Deductibles
A deductible is the amount you owe before your health insurance plan begins paying benefits, either individually or as a family unit. Some plans offer multiple deductibles – for in-network care and out-of-network care separately.
Texas residents may qualify for assistance paying their Obamacare premiums through subsidies available from either the government marketplace or licensed insurance brokers, like eHealth. To see if you’re eligible, click here.
Since 2014 when ACA exchanges launched, health insurance costs have steadily been on the rise. Deductibles on popular bronze plans have steadily increased while premiums remained relatively steady; this bodes well for consumers and should continue in 2022 due to restoration of cost-sharing reduction payments from insurers – this should keep premiums affordable while giving enrollees greater choice regarding coverage they find most suitable.
Co-pays
Health insurance plans that include copays and deductibles tend to be more expensive than those without them, however the ACA requires all plans to include essential health benefits, including prescription drug coverage. This makes health insurance less costly for many people who do not have preexisting conditions such as cancer.
The Affordable Care Act also ensures health insurance providers do not deny coverage to individuals with preexisting conditions and allows parents to keep their children on their health plans until they turn 26 years old. While these provisions have provided millions with access to affordable healthcare coverage, some still do not have such access.
Texas enrollees who meet certain income requirements often receive advanced premium tax credits to offset the costs of health insurance premiums, with subsidies available up to four times above poverty rate. Individuals not receiving such subsidies have been leaving Texas exchanges in large numbers.
Out-of-pocket maximums
An out-of-pocket maximum is the highest annual amount a covered individual or family will have to pay for in-network healthcare and prescription costs that fall under their health plan’s coverage, designed to protect consumers from high costs. It is important for individuals and families to understand how these limits operate as they differ from deductibles and copayments.
Limits vary by health plan; for 2023, an individual Marketplace plan’s out-of-pocket limit cannot exceed $9,100 and that of a family plan may not go beyond $18,200 before federal subsidies apply.
The Affordable Care Act (ACA) offers financial help to lower insurance premiums, deductibles, and copayments for most people who enroll through exchanges. Texas saw an impressive 91% of exchange-based enrollees receiving subsidies this year–an impressive increase from 85% in 2015. This rise may be attributable to the Supreme Court decision upholding federal subsidies for their Obamacare marketplace in Texas.
