Photograph by Photocreo Bednarek on Adobe Stock
Navigating Health Insurance in Texas
Texas residents have various health insurance options to consider, whether seeking individual coverage, employer-sponsored plans, or government-assisted programs. Understanding these choices is crucial for making informed decisions about healthcare coverage.
Marketplace Plans and Subsidies
Texans under 65 can access health insurance through the federally operated Health Insurance Marketplace. For the 2025 plan year, a number of insurers offer coverage in the Texas Marketplace, providing a range of options for consumers. Financial assistance is available for many customers. Approximately 90% of enrollees receive premium tax credits, with an average monthly savings of $536. Notably, 62% of enrollees pay less than $10 per month after subsidies. However, it is critical to be aware that enhanced subsidies under the American Rescue Plan will expire at the end of 2025. Without legislative action to extend them, premiums could increase by an average of $460 annually for many Texans.
Enrollment Periods
If there are no changes in the future, the Marketplace Open Enrollment Period coverage will take place from November 1 to January 15. To ensure coverage starts on January 1, consumers must enroll by December 15. Outside this window, individuals may qualify for a Special Enrollment Period due to life events such as marriage, childbirth, or loss of other coverage. Blue Cross Blue Shield of Texas provides guidance on qualifying events and enrollment procedures. Some of the qualifying events include:
- Losing or getting denied Medicaid or the Children’s Health Insurance Program (CHIP) coverage
- Adopting a child or gaining a dependent through a court order
- The passing of a policyholder
- Moving to a new area with different plans or HMO network
- Getting married
- Turning 26 while on a family member’s policy
- Separating or divorcing your spouse
- A change in income or household status
- An employer offers to help with your coverage cost (through an ICHRA or QSEHRA)
- Your health care coverage ending on a date other than December 31 of the current plan year
- Having an annual individual or household income at or below 150% of the federal poverty level
A full list of qualifying events can be found here.
For those over 65, the Medicare Annual Enrollment Period (AEP) lasts from October 15 to December 7 each year. During this period, Medicare beneficiaries can change their health plan or keep their plan from the previous year. Of course, to keep the same plan, the insurance company must still offer that plan for the upcoming year.
Government Programs
Texas offers eligible low-income residents Medicaid and the Children’s Health Insurance Program (CHIP). However, the state has not expanded Medicaid under the Affordable Care Act, resulting in a coverage gap. Texas also has the highest rate of uninsured children in the U.S., with nearly 12% lacking coverage in 2023. Many of these children are eligible for Medicaid or CHIP but face enrollment barriers due to procedural issues and application complexities.
Employer-Sponsored Plans
There are quite a few Texans who receive health insurance through their employers. For example, the HealthSelect of Texas plan serves state employees and sets the 2025 in-network annual out-of-pocket maximum at $8,050 for individuals and $16,100 for family coverage.
It remains vital to note that changes in employer-sponsored plans can affect costs and coverage. For instance, the Houston Independent School District switched to UnitedHealthcare from another carrier. Doing so raised employee concerns about higher deductibles and prescription costs.
Advice for Selecting a Plan
When choosing a health insurance plan in Texas:
- Determine Your Necessities: Consider your healthcare needs, including favored doctors, medications, and expected medical services.
- Compare Plans: There are different way an individual can go about comparing plans, but seeking the help of independent experts in the industry is wise. Speak to a licensed agent, like those at Empower Brokerage, to compare coverage options and costs.
- Check for Subsidies: See if you are eligible for financial aid to lower premiums and out-of-pocket costs.
- Understand Plan Types: Familiarize yourself with different plan structures (e.g., HMO, PPO, EPO) to choose one that aligns with your preferences. Once again, a licensed agent can assist you in assessing these factors of a health plan.
Private Insurance Options for Seniors: Tailored Plans That Fit Your Needs
We understand how important it is for you to find a plan that is affordable, easy to use, and aligned with your lifestyle. If you are exploring private insurance options outside of Original Medicare, you will be pleased to know that Texas offers a variety of plans designed with your needs in mind.
Private insurance carriers offer Medicare Advantage (Part C) plans that often include extra benefits.
For seniors who prefer to stick with Original Medicare but want help covering deductibles, coinsurance, and copayments, Medicare Supplement plans (Medigap) are a great option. These plans give you predictable out-of-pocket costs and the freedom to visit any doctor or hospital that accepts Medicare.
Our licensed agents work closely with you to:
- Review your current healthcare needs and medications.
- Compare plans from multiple carriers side-by-side.
- Explain network differences and help you find doctors in your area.
- Ensure you qualify for all available financial assistance programs.
Whether you are enrolling for the first time or want to make a change during the Annual Enrollment Period, we are here to guide you every step of the way.
Perhaps you are Medicare-eligible or nowhere close to 65. Either way, navigating health insurance options in Texas requires careful consideration of available plans, costs, and eligibility for assistance programs. By staying informed and utilizing available resources, Texans can make choices that best suit their healthcare needs and financial situations.
If you found this article helpful, please read another helpful article about the 8 best uses of health insurance.
Got Medicare Questions?
We hope that this information on health plans in Texas is useful to you.
Let us help you answer your questions so that you can get back to the activities that you enjoy the most.
Call (888) 446-9157, click here to get an INSTANT QUOTE, or leave a comment below!
See our other websites: