Houston, TX Obamacare Guide

There are three primary ways to reduce the cost of health plans under the Affordable Care Act in Texas.

• You may be able to lower the cost of monthly premiums when you sign up for a private health insurance plan. Your subsidies will come in the form of a federal tax credit. This article is updated to cover the new tax credits available under the American Rescue Plan Act of 2021.
• You may be able to reduce your out-of-pocket costs -- including copayments, deductibles, and coinsurance -- with cost-sharing subsidies paid for by insurers.
• You may qualify for free or low-cost coverage through Medicaid in Texas, or your children may be able to obtain coverage through the Children’s Health Insurance Program (CHIP).

Each of these forms of assistance depends on your income and family size.

Many people who apply for coverage at the Texas exchange will be eligible for some form of financial assistance. Read on to learn more about each option.

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There's No Federal Tax Penalty for Being Uninsured

Legally, the Affordable Care Act -- aka Obamacare -- still says that you must have health insurance. Practically speaking, however, the tax penalty for being uninsured has dropped to zero. That means you'll still have to report your coverage status on your federal tax return, but you won't have to pay a penalty if you aren't covered.

A handful of states have passed their own health insurance requirement to replace the federal mandate. As we approach open enrollment for 2021 health plans, those states are California, the District of Columbia, Massachusetts, New Jersey, Rhode Island, and Vermont.

Get a colonoscopy, mammogram, vaccinations, and other essential services for free

The Affordable Care Act requires health insurance plans to offer certain preventive care services free of charge -- or more accurately, for nothing more than the cost of your monthly insurance premiums. This rule applies to most plans sold directly by insurance companies and all plans sold through Healthcare.gov, the health care marketplace for Texas. Covered preventive services are available for free (meaning no co-pay or other out-of-pocket charges) whether or not you’ve met your plan’s annual deductible.

Tips for Using Your Preventive Care Benefits – And Avoiding Unexpected Charges

Below, you’ll find a list of free preventive benefits -- screening tests, counseling services, and vaccinations -- for adults, women, and kids. But first, here are some pointers to help you avoid an unexpected bill for services you thought were preventive.

Use a network provider. To get a preventive service for free, you must use a health care provider in your insurance plan’s network.

Know the difference between “preventive” and “diagnostic.” Doctors can use screening tests for either preventive or diagnostic reasons. For example, having a routine mammogram every year or two is preventive care for women over 40. But if you schedule a mammogram because you feel a lump or have breast pain, that’s diagnostic. Likewise, a routine colonoscopy is recommended for adults over 50, but if your doctor schedules a colonoscopy to investigate a problem like blood in your stool, it becomes a diagnostic procedure. Preventative services are free; diagnostic procedures are not. (If the timing is right -- say, you go to the doctor because you find a lump in your breast but you also happen to be due for an annual mammogram -- your doctor may bill the diagnostic procedure as preventive, but that’s not something you can count on.)

Get Help Finding a Health Insurance Plan in Texas

Get Help From Texas's Health Insurance Exchange

The following links and telephone numbers take you to the official help resources for Healthcare.gov, the health insurance marketplace for Texas.

Help by phone: 800-318-2596 (TTY: 855-889-4325)

In-person help: Go to Find Local Help, where you can enter your city and state or zip code to find an application assister, insurance agent, or health insurance broker in your area.

Get Help From a Licensed Insurance Broker

To directly connect with a Texas insurance broker who can help you evaluate insurance plans and choose a plan that's appropriate for your situation, call 800-943-6832. (We receive advertising income from the licensed brokers who offer their services through this telephone number.)

More Information

For more detailed information, see How Do I Sign Up for Obamacare in Texas?

Many self-employed people will be quick to tell you that getting and paying for health insurance is one of the biggest challenges they face. For some, however, the Affordable Care Act (Obamacare) may make things easier by providing new coverage options for the self-employed.

Are You Self-Employed or an Employer? 

Before you start evaluating your options for health coverage, you need understand whether the Affordable Care Act thinks you're self-employed.

The ACA says you are self-employed if you are an independent contractor or a sole proprietor without employees. (If you hire other independent contractors to do some work for you, you probably still qualify as self-employed.) If you are self-employed, you can use Healthcare.gov to compare health insurance plans and sign up for the one that works best for you.

If you have employees – usually, workers whose income you report on a W-2 at the end of the year -- you’re considered an employer. In that case, you can learn about purchasing health insurance for yourself and your employees through the SHOP Marketplace. You will be connected with a registered SHOP (Small Business Health Options) agent or broker who can help you understand your coverage options.

If you aren’t sure whether the people who work for you are independent contractors or employees, read "Independent Contractor (Self-Employed) or Employee?" on the IRS website.

What the Affordable Care Act (Obamacare) Means for Self-Employed People in Texas

Here are seven things self-employed people should know about the Affordable Care Act:

When registered domestic partners or civil union partners apply for coverage at an Affordable Care Act health insurance marketplace, there’s one question that almost always arises: Do we apply based on our separate incomes or must we include all the income we make as a couple?

The answer depends on the state where you live.

States other than California, Nevada, or Washington. In almost all states, registered domestic partners or civil union partners who apply for insurance via the state’s health insurance exchange must do so separately. Each partner includes only his or her separate income, and this amount determines health plan costs and eligibility for cost-saving subsidies. It works this way because domestic partners are not considered married for federal tax purposes. (If you registered first and got legally married later, this article doesn't apply to you. You must apply as a married person and report your combined income.)

If someone calls you on the phone in Texas offering you discount health insurance for $29 a month, hang up and report them to the Texas Department of Insurance. 

Worthless insurance is one of many scams that unscrupulous people are trying to sell to consumers confused by Obamacare. To satisfy the requirements of the new law, you must have a qualified insurance plan. If you don't, not only will you miss out on cost-saving insurance subsidies, you will probably be subject to a tax penalty.

Beware of scammers who may try to persuade to you buy insurance outside of Healthcare.gov. Below is a list of common types of scams.

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If you’re over the age of 65, your health insurance options under the Affordable Care Act (Obamacare) depend on whether or not you’re covered by Medicare or another insurance plan. To find out what, if anything, you need to do, find the situation below that applies to you.

You have Medicare. If you’re already enrolled in Medicare, you’re considered covered under the ACA, and you don’t have to do anything. In fact, it’s illegal for someone who knows you have Medicare to try to sell you a plan through an ACA health insurance marketplace.

The Affordable Care Act does enhance your existing Medicare coverage by providing additional preventive care benefits, such as cancer screenings and an annual wellness visit.

For more information on Medicare coverage, go to Medicare.gov.

Can I Use a Paper Application to Get Obamacare?

When Obamacare first launched, the federal and state health insurance marketplaces (also called “exchanges”) were plagued by technical troubles. Many people who tried to sign up for new health insurance plans online in the early days were unable to complete their applications.

Because of these difficulties, some individuals and application assistants turned to the old-school way of getting health insurance -- paper applications.

Applying on Paper May Not Be Better or Faster

When facing a slow or broken online health insurance exchange, using a paper application may seem tempting -- at least it would provide the feeling of getting something done. However, paper forms may not speed up the process at all. On the contrary, they could slow down your application even more.

The worker who reviews your paper application must manually enter the information from your forms into the same system you would use online at your state’s exchange. It won’t work any faster for them than it does for you. Plus, using a paper application opens up more opportunity for error by putting more people between you and your goal of getting insurance.

It’s still best to apply online if you can. That said, if you feel that you’re unlikely to come back and apply for health insurance later, you may want to go ahead and complete a paper application now. 

To get a paper application, call the Healthcare.gov customer service center and let them know you want to apply on paper. They'll point you to a downloadable application or send you one in the mail. For detailed Healthcare.gov contact information, see How To Sign Up for Obamacare in Texas.

Are you planning to get married, change jobs, or move to a new state? If so, you might have to share your big news with Healthcare.gov.

Which Changes Must You Report? 

If you buy a health insurance plan through the Texas marketplace, the Affordable Care Act requires you to report changes that may affect your insurance coverage. These changes include: 

• moving to a new state or insurance coverage area
• significant changes in income
• getting new health coverage through a job
• signing up for Medicare or Medicaid
• getting married or divorced
• becoming pregnant, having a child, adopting a child, or placing a child for adoption
• losing or gaining a dependent
• becoming disabled, and
• other changes that affect your income or household size.

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We built this website to get people the answers they need about the Affordable Care Act (Obamacare). Our goal is to guide you to reliable, local information about your new health insurance options.

When you choose your state or enter your zip code here, you will quickly learn:

• whether or not you're required to get health insurance

• what the available plans cover

• how much coverage will cost, and

• how to sign up in your state.

For those concerned about cost, we show you how to determine whether you qualify for subsidies.