Health Insurance Affordable Care Act

Texas Health Insurance Marketplace

Who Is the Marketplace for?

The Texas Health Insurance Marketplace is where eligible residents can shop for and buy insurance in person, online, or by phone. In Texas, the Marketplace is run by the federal government. The Marketplace, also called an Exchange, is mainly for people who:

• Don’t have insurance
• Aren’t insured by their employer
• Don’t have Medicare
• Aren’t included in their spouse’s employer insurance
• Have pre-existing conditions and may have had trouble getting insurance before
• Have private insurance but want to look at other options
• Own a small business

The Affordable Care Act  required most Americans to sign up for health insurance  in 2014 or pay a fine at income tax time. Generally, you don't need to buy insurance through the Marketplace if you are covered by Medicaid. Medicare, TRICARE, or an employer-sponsored plan.

When You Can Enroll:  The next open enrollment period is Nov. 1, 2015, to Jan. 31, 2016. Enroll online at HealthCare.gov  or call 800-318-2596. You can also download an enrollment application at HealthCare.gov. or get help in person through a Navigator or insurance broker.

If you have a life-changing event -- such as the birth of a child, losing your job, or moving to a new state -- you don't have to wait for the next enrollment period. You can sign up or change coverage within 60 days of the event. You can also sign up for Medicaid at any time, if you are eligible.

Plans and Costs

Getting Started. You’ll need to provide information about you and your family members when you apply. Here’s a checklist of what you’ll need:

• Social Security number (or document number if you are a legal immigrant)
• W-2 forms: Wage and tax statements or pay stubs for all employed members of the household; for people who are self-employed or do not have a regular salary, include an estimate of household income.
• Policy numbers of health insurance plans covering any members of the household
• Immigration/citizenship status
• Tobacco use

Types of Plans: All insurance plans on the Marketplace are sold by private companies or co-ops. They can offer four types of coverage: bronze, silver, gold, and platinum. These “metal level” plans all cover the same kinds of benefits. The difference is how much they pay on average toward the costs of health care services. Another type of plan is called catastrophic. These have less expensive monthly fees called premiums, but they also offer less coverage. Catastrophic plans are mainly for healthy people under 30.