Texas Health Insurance

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Snapshot of Texas Health Insurance

  • Total Texas Residents – 27,469,114
  • Texas uninsured residents – 19.1 percent

*Source: Trust for America’s Health

Do you need to buy Texas health insurance?

Yes. Under Obamacare there is an Individual Mandate that requires U.S. citizens under the age of 65 to enroll in a health insurance plan or pay a fine. For 2015, not carrying insurance cost $325 per adult plus $162.50 per child (up to $975 per family) or 2 percent of your family’s income, whichever was more.

In 2016, your penalty for not having health insurance is 2.5 percent of your household income or $695 per person — whichever is higher. That’s a big increase from the 2015 penalty, which was 2 percent of your household income or $325 per person.

What are my options for buying affordable Texas health insurance through Obamacare?

As a resident of Texas, you have multiple options to choose from when it comes to choosing your Texas health insurance. You have access to affordable Texas health plans from multiple Texas health insurance carriers in 5 coverage levels, commonly called metal tiers.  The different insurance plan categories offer flexibility. So you can choose a health plan that’s best for you and your family based on the amount of health care you’re likely to need in the coming year.

Platinum is the most expensive option, but it offers the best cost-sharing benefits, covering 90 percent of health expenses.

  • If you know your family will use a lot of medical services, and you don’t qualify for Cost Sharing Reduction subsidies, Platinum plans can end up providing the best value.
  • If you are leaning toward a Platinum plan – make sure it’s for the right reasons. This plan should be purchased because it fits your healthcare needs, not because you want the best. Starting in 2018, high-end health insurance plans with be subject to an excise tax.

Gold is the second most expensive option. If you don’t mind paying a higher monthly premium to have a higher percentage of health care costs paid by your plan, a Gold plan may be the right choice for you.

  • Gold plans will typically cover 80 percent of covered health care expenses received in network. You pay the remaining 20 percent in the form of out-of-pocket expenses, such as deductibles, co-payments or co-insurance.

Silver is the most popular option. A Silver plan has lower out-of-pocket costs than the Bronze plan, but higher out-of-pocket costs than the Gold and Platinum plans.

  • Silver plans will typically pay 70 percent of covered health care expenses received in network.You pay the remaining 30 percent in the form of out-of-pocket expenses such as deductibles, co-payments, or co-insurance.

Bronze is intended to have the lowest premium of the metal tiers of health plans under the Affordable Care Act because it has the highest out-of-pocket cost compared to the other plans.

  • If you choose a Bronze plan your insurance will typically pay 60 percent of covered healthcare expenses with the remaining 40 percent to be paid by you – the consumer.
  • This does not mean that the insurer will pay 60 cents of every dollar of your healthcare expenses. Your expenses are tallied in the form of out-of-pocket fees over and above the cost of the plan’s monthly premium.
  • Out-of-pocket expenses in 2016 are capped at $6,850 for individual plans and $13,700 for family plans, though plans can apply lower limits if they so choose.

Catastrophic plans are offered by some states. Catastrophic plans do not cover any percentage of health expenses, and serve as the most limited form of affordable Texas health insurance coverage available in the Obamacare market. Only persons ages 30 and younger or persons of any age with a hardship exemption may opt to purchase these plans.

  • Catastrophic health insurance plans have low monthly premiums and a very high deductible — $6,850. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. You pay most routine medical expenses yourself.

Based on 2014 enrollment figures, Silver plans are the most popular choice amongst Americans who purchased Obamacare plans.

In order to find a plan that best meets your needs, you should consider four main components: the monthly premium cost; the range of benefits covered by the plan; the breadth of the health plan’s network; and the cost-sharing requirements associated with a plan’s benefits. Your monthly premium is determined by your age, where you live, and whether you use tobacco. Depending on your family’s income, you may qualify for a tax credit to help you pay for coverage.

Where do I buy affordable health insurance?

Your search for Texas health insurance starts here. We partner with a number of agencies participating in Texas’s health insurance marketplace, help to ensure that you’re getting the best possible price for your health insurance coverage. Simply complete this form or call 855-885-2798 to compare Texas health insurance plans now.


What’s the difference between a Texas HMO plan and Texas PPO plan?


If you choose a Health Maintenance Organization (HMO)you will have access to doctors and hospitals within the plan’s approved network. An HMO network is made up of health care providers that have agreed to certain rates for plan members. This typically results in lower premiums and/or copayments.

Unlike PPO insurance plan types, care is covered only if you see a provider within your HMO’s network. In addition, your HMO plan will only cover your visit to a health care specialist (obstetrician, cardiologist, rheumatologist) if you get a referral from your primary care physician.An HMO plan usuallyinvolves more restrictions, such as allowing only a certain number of visits, tests or treatments per year.

In general, HMO plans will have the following characteristics:

  • Lower monthly premiums
  • Must see primary care physician for a referral before seeing a specialist
  • If you seek care outside of your network (emergencies excluded), your insurance won’t cover the cost


A Preferred Provider Organization (PPO) is a managed care health plan that gives you access to multiple choices in health care and health care providers. The network of physicians in a PPO is often much larger than an HMO and you will be able to refer yourself to physicians outside of the network, but you may pay a higher copayment for this service.  Unlike HMO plans, the PPO plan does not require the use of a primary care physician (PCP) referral to see a specialist.

In general, PPO plans will have the following characteristics:

  • Higher monthly premiums
  • Higher co payments
  • Referrals aren’t needed to see a specialist
  • You can see any health care professional you want – inside or outside of your PPO network. However, going outside of your PPO network may cost you more

Who is exempt from insurance?

The individual mandate requires most everyone to purchase health insurance or pay a penalty. You may qualify for an exemption from the Obamacare penalty if you are:

  • Uninsured for less than 3 months
  • Unable to find a plan that would cost less than 8 percent of your household income
  • A member of a recognized health care sharing ministry, a recognized religious sect with religious objections to insurance or a federally recognized tribe
  • Incarcerated
  • Qualify for a hardship exemption

If you don’t qualify for a subsidy (a tax credit), you can still enroll in an Exchange Plan, or consider one of the many private health insurance plans available in Texas’s private marketplace. We provide free quotes to help match you with the best plan to meet your needs and budget.

What if I don’t buy Texas Health Insurance?

It is not recommended to go without insurance. There’s a 1 in 5 chance you will land in the ER at some point between the ages of 25 and 44, a trip that could cost you up to $1,450, according to WebMD. A surgery on a broken arm, for example, could cost more than $16,000 in medical bills if you’re uninsured. If that’s not convincing enough, 1 in 4 uninsured people will lose all their savings to medical bills, which is the leading cause of bankruptcy in the U.S.

The bottom line is that purchasing some form of affordable health insurance in Texas is a good idea. And remember that under the Affordable Care Act (ACA), you now must pay a penalty tax for going without health coverage unless you meet certain exemption criteria.

I am in between jobs – can I buy short-term insurance?

Texas short-term health insurance plans offer health care coverage for a limited period of time (around 1 to 12 months) and are a great solution when you’re between jobs, waiting for group coverage to start, or if you’re a recent college graduate.Simply complete this form or call 855-885-2798 to compare coverage plans and prices today.

Short-term health insurance plans rarely cover pre-existing medical conditions. A pre-existing medical condition is usually defined as conditions that have been diagnosed or treated within the previous 3 to 5 years. If you have an existing medical condition, it’s a good idea to research whether you can extend your current insurance. Employer-sponsored insurance can be extended under a government-regulated option commonly referred to as COBRA.

Can I purchase an affordable family health insurance plan?

Family health insurance is probably one of the most important purchases you’ll ever make. We simplify a complicated process and help you find the right balance between premium payments and the medical services your family needs. Simply complete this form or call 855-885-2798 to find affordable family health insurance coverage today.

Can I purchase Obamacare coverage for my children and not for myself?

Yes – you can purchase insurance for your children and not include yourself in the coverage. Simply complete this form or call 855-885-2798 to compare coverage plans and prices today. Note that if you and your spouse are uncovered, you will be subject to the tax penalty.

Can I buy an affordable dental insurance plan?

We can help you compare affordable dental plans designed to meet different needs. Take care of your oral health with a range of dental discount plans and dental insurance options. You’ll also be able to compare rates and benefits for individual dental coverage or family dental coverage. Simply complete this form or call 855-885-2798 to gain access to a large network of dental providers.