As open enrollment is quickly approaching, you must know your health insurance options for the 2023 period. For Texas, comparing and enrolling in an ACA health plan can be completed through the healthcare.gov federal website. This article is the most affordable ACA plan available for residents of Texas, based on the deductible and monthly premium.
What Are the Best Plans in Texas
The chart below shows the top 15 ACA healthcare plans available in Texas for the 2023 enrollment period. For this article, we are looking at the most affordable plans for a 28-year-old female who is not a tobacco user with an average annual income of $80,000. Additionally, her zip code is 77059, which puts her in the Houston, Texas, Area. Based on her profile, the monthly premium for an ACA plan in Texas can range from $267.00 to $368.00.
Best ACA Marketplace Plans in Texas
|MyBlue Health Gold 403||Gold, HMO||$321.70||$1,100|
|Community Health Choice Gold 022||Gold, HMO||$334.46||$2,200|
|Ambetter From Superior HealthPlan, CMS Standard Gold Value||Gold, HMO||$339.85||$2,000|
|Ambetter From Superior HealthPlan, Everyday VALUE Gold||Gold, HMO||$342.56||$750|
|Aetna CVS Health, Gold S||Gold, HMO||$375.43||$2,000|
|Ambetter from Superior HealthPlan, CMS Standard Silver VALUE||Silver, HMO||$376.88||$5,800|
|Ambetter from Superior HealthPlan, Focused VALUE Silver||Silver, HMO||$377.14||$6,100|
|Community Health Choice, Community Select Silver 019||Silver, HMO||$378.43||$4,900|
|Ambetter from Superior HealthPlan, Clear VALUE Silver||Silver, HMO||$378.56||$5,400|
|Oscar Insurance Company, Silver Simple PCP Saver||Silver, EPO||$430.73||$5,500|
|MyBlue Health Bronze 402||Bronze, HMO||$265.34||$7,400|
|Community Health Choice, Community Select Bronze 016||Bronze, HMO||$274.56||$8,100|
|Aetna CVS Health, Bronze S||Bronze, HMO||$276.92||$7,500|
|Oscar Insurance Company, Bronze Simple- Standard||Bronze, EPO||$289.89||$9,100|
|Oscar Insurance Company, Bronze Simple||Bronze, EPO||$301.86||$8,500|
Like other states, you can sign up for an ACA plan in Texas during the open enrollment period, from November 1, 2022, to January 31, 2023. There are three ways that you can apply for an ACA plan in the Texas marketplace:
- Over the phone, by speaking to a government representative (1-800-318-2596)
- By mail with a paper application
- Online through a licensed insurance broker such as eHealth
What Should I Consider When Picking a Health Plan?
When looking for a health plan, you should consider a few things. First, you must consider your health needs, finances, and how much you can afford. These things will likely change as time goes on, but understanding before selecting will help you make the best decision.
What are your health needs?
When picking a health plan, you want to consider your health needs. This includes what medications you currently take, chronic conditions like diabetes, and how often you need to see your medical provider. If necessary, do you need to see specialists? Does the specialist require a referral from your primary care physician? Finally, consider whether you plan on making any major life changes soon.
Life changes can include:
- Having a child
- Getting married
- Retiring early
- Switching careers
Once you’ve figured out your health needs, you can move on to the next step of deciding which health plan is best for you. Some health plans also provide you with dental and vision care.
If you’re looking for a health plan to cover you and your family, you can still consider the above to help rank your options. If you’re married, your spouse may receive health insurance through their job; check to see if their plan offers more benefits.
Get Mira - Health Benefits You Can Afford.
Get doctor visits, lab tests, prescription, and more. Affordable copays. Available in 45+ states. Only $45/month on average.
What’s your financial situation?
After you’ve thought about your health needs, take the time to calculate your budget moving forward. Including things like housing, transportation, and even entertainment costs is important. Then you can see how much of your budget can go toward health insurance.
If you’re someone with an income that fluctuates, such as a freelancer or short-term contracted employee, you should consider how this will impact your budget at its highest and lowest. For people who live in cities with a high cost of living, you will find that the average cost of health insurance for one person varies compared to cities with a low cost of living.
You’ve done your budget and understand how much your current lifestyle affects your finances. Be mindful not to spend all your money on health insurance, as you still need a savings account. We’ve even figured out a few things to keep in mind when lowering your expenses.
How much can you afford?
You have your health needs and budget figured out. Now you can select the health plan that will best meet your needs. If you find that you will have a high deductible, you can offset that with a service like Mira that offers a significant discount on lab tests and prescriptions.
If you decide to select a high deductible health plan (HDHP), you will find that you will have a lower monthly premium. These plans are typically helpful to relatively healthy people who don’t plan to have significant medical expenses. You can pair an HDHP with a Health Savings Account (HSA), which allows you to use your pre-taxed funds towards medical expenses like copays and deductibles. However, you cannot use this to pay for your monthly premium. Average monthly premiums vary from state to state for each metal tier. The chart below shows the average premium cost per metal tier in Texas.
|Average Lowest Cost, Bronze Premium||Average Lowest Cost, Silver Premium||Average Lowest Cost, Gold Premium|
What if you frequently travel?
If you travel a lot and need coverage during this time, look at PPO plans. Preferred Provider Organization plans will give you access to out-of-network coverage and allow you to see specialists without a referral. These plans do often come with a high premium and vary per state.
What happens if you can’t afford any plan on the exchange?
If you cannot afford a healthcare plan through the texas-based marketplace, there are options to lower health insurance costs. Once you enter your personal and income information, the marketplace will determine if you qualify for insurance affordability programs. This includes Medicaid, Child Health Plus, the Essential Plan, Advance Premium Tax Credits or Cost-Sharing Reductions.
If you do not qualify for any affordability program, and the cost of marketplace insurance does not fit in your budget, Texas residents do not get a tax penalty for not having insurance.
ACA Health Plans in Texas Frequently Asked Questions (FAQs)
Below are some frequently asked questions about health insurance in X State we gathered for you.
Virtual care for only $25 per visit
Virtual primary care, urgent care, and behavioral health visits are only $25 with a Mira membership.
What health insurance terms should I understand during this enrollment period?
We’ve gone over PPO, HDHP, and HSA. You should also know what a Flexible Spending Account (FSA), Self-Pay Pricing (SPP), and Special Enrollment Period (SEP) are. We have a list with a few more insurance terms that will help you during this enrollment period.
What requirements do I need to meet to be eligible in Texas?
To be eligible for marketplace insurance in Texas, you must be a resident of Texas, not incarcerated, and a U.S. citizen or national.
What are the benefits that my plan is required to provide?
In the federal marketplace, all plans must cover 10 essential health benefits:
- Ambulance Services
- Emergency Services
- Hospitalizations (surgery and overnight stays)
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Lab services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
When is the special enrollment period?
If you miss open enrollment and you’ve had a qualifying life event such as having a baby, a change in income, or health insurance loss, you may be able to apply 60 days prior or 60 days after the event to enroll in a health plan. To see if you qualify, go to healthcare.gov and fill out a few questions. The site will direct you to either answer more questions or to the site for Texas.
Texans can access a comparison tool and sign up for healthcare insurance through the federal marketplace. Depending on the type of plan and metal tier, your monthly premium can be between $324 and $457. It can be reduced if you qualify for affordable health programs.
If you are looking for an alternative to individual health insurance, membership plans such as Mira are a great option for access to high-quality care. For an average of $45 a month, Mira members get access to low-cost virtual and urgent care visits, up to 80 percent off select medications, and same-day lab testing. Sign up today!
Originally from Houston, Texas, Alexandra is currently getting her Master's in Public Health with a health policy certificate at Columbia University. One of her life goals is to own her own art gallery!