What Texas Residents Need to Know About Obamacare for 2023
In Texas, Affordable Care Act (Obamacare) open enrollment is over, but you may still qualify for 2023 coverage.
This website provides information about getting health insurance under the Affordable Care Act (ACA), including:
- whether you must get health insurance
- what the available plans cover
- how much coverage will cost
- how to sign up for a plan
- how to get help if you need it.
To begin, keep in mind these key points about health insurance in Texas:
1. Texas open enrollment has ended, but you may be able to use a special enrollment period to get covered.
In Texas, open enrollment for 2023 Affordable Care Act (Obamacare) coverage has ended. This means that, unless you qualify for an exception or your income is low enough for Medicaid, you won't be able to get health insurance through Healthcare.gov until open enrollment for 2024 begins next fall.
If you’ve lost your job or significant income in the past 60 days, you might qualify for a special enrollment period (SEP). A SEP allows you to sign up for a new health insurance plan or change your current one outside the open enrollment window.
In addition to job or income loss, many other qualifying events may make you eligible for a SEP. To learn more, see What Happens If I Missed the Texas Obamacare Enrollment Deadline?
2. If you lose Medicaid or CHIP coverage due to the end of federal pandemic protections, there's a SEP just for you.
The federal government will initiate an "Unwinding SEP" on April 1, 2023 for those kicked off of Medicaid or CHIP due to expiring COVID-related policies. Losing Medicaid or CHIP coverage always makes you eligible for a 60-day Special Enrollment Period, but this SEP lets you enroll in an ACA plan for up to 16 months, through July 31, 2024.
3. You won’t face a tax penalty for going without health insurance in 2023—but there are big downsides to being uninsured.
Obamacare’s tax penalty went away in 2019. That means that if you don’t have health insurance, you won’t have to pay a penalty when you file your federal income taxes. That said, think about whether it makes sense to forego health insurance. A medical crisis could knock the financial wind from your sails and do more damage than the penalty. (A study published in 2019 showed that a lapse in health insurance coverage can double a person's chances of ending up in bankruptcy.)
In 2021, President Biden signed the American Rescue Plan Act (ARPA). The law provided $1.9 trillion of federal aid to Americans struggling with the COVID-19 crisis, including additional premium subsidies for those who purchase health insurance through Healthcare.gov. In 2022, the Inflation Reduction Act extended these more generous subsidies through 2025. Here’s a quick summary of the types of available subsidies.
Federal tax credits. Under ARPA, no one will have to pay more than 8.5% of their household income for a mid-level plan purchased from Healthcare.gov. Technically, the subsidies are tax credits, but you can choose to have them automatically deducted from the cost of your monthly premiums.
Cost-sharing subsidies. More than half of the people who purchase coverage through Healthcare.gov receive assistance through cost-sharing reductions (CSRs). CSRs automatically reduce your premiums and lower your costs when you use your insurance benefits—for example, when you go to the doctor, get lab work, or have to stay in the hospital.
CSRs are available to people who make between 100% and 250% of the federal poverty level. (For 2023 health plans, that means a family of four in Texas can't earn more than $69,375 and an individual not more than $33,975.) But these benefits are available only on silver plans. If you think you may qualify, look carefully at the costs for silver plans available at Healthcare.gov while shopping for coverage.
Medicaid. You may qualify for free or low-cost coverage through Medicaid in Texas if your income is very low.
All subsidies will be automatically calculated when you apply for a plan through Healthcare.gov.
For more information, see Ways to Save Money on Obamacare in Texas.
5. Average premium rates went up for 2023, but that doesn't mean everyone is paying more.
Nationwide, the average rate increase for 2023 health plans was about 7.7%. However, these numbers aren't final; more importantly, this doesn't tell you how much you'll pay for health insurance. Costs vary from state to state and plan to plan within a state. For example, premiums increased an average of more than 8% in Texas, while Virginians generally saw a decrease of 13%. Also, when premiums for the benchmark plan (the plan used to determine subsidy amounts) go up, subsidies go up, too. This is a long way to say don't let the numbers get you down. Comparison shop at Healthcare.gov to find the plans and subsidies available to you.
6. Avoid short-term insurance plans that don’t comply with the ACA.
In 2018, the Trump administration made purchasing short-term insurance plans easier. Short-term plans don’t have to cover preexisting conditions or the essential health benefits provided by Obamacare plans. In the past, short-term plans were allowed to last only three months, but under new rules, you can purchase a non-ACA-compliant “short-term” plan that lasts as long as three years.
If you’re genuinely caught without health insurance and need it for a few months to cover a new health condition, you might want to consider a true short-term plan to get you through to the next open enrollment period. Otherwise, be careful of plans that don’t meet the requirements of the Affordable Care Act, and shop around to look for coverage that truly meets your needs.
Remember, if your income is very low, you may qualify for free or low-cost coverage through Medicaid in Texas.
7. You can get help signing up if you need it.
The Biden administration has greatly increased enrollment assistance, making it much easier to get the information you need to get covered. To connect with local support resources, see How To Sign Up for Obamacare in Texas.