In Texas, Affordable Care Act (Obamacare) open enrollment is over, but you may still qualify for 2022 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 2022 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 2023 begins next fall.
If you’ve lost your job or significant income in the past 60 days, whether due to the COVID-19 pandemic or for any other reason, 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 plan 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. You may qualify for new Affordable Care Act subsidies.
Last year, President Biden signed the American Rescue Plan Act (ARPA). The law provides $1.9 trillion of federal aid to Americans struggling with the COVID-19 crisis. The relief measures include additional premium subsidies for those who purchase health insurance through Healthcare.gov. People who apply for 2022 coverage under a special enrollment period can access these subsidies. (Under the Inflation Reduction Act, the additional subsidies are set to expire at the end of 2025.)
Federal tax credits. Until the passage of ARPA, the ACA provided premium subsidies only to those whose income fell between 100% and 400% of the federal poverty level. For example, the cutoff for a family of four in Texas used to be $104,800. For an individual, it was $51,040.
At least through 2022, 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 when you purchase a plan through Healthcare.gov.
Cost-sharing subsidies. More than half of the people who purchase coverage through Healthcare.gov receive assistance in the form of 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 2022 health plans, that means a family of four in Texas can't earn more than $65,500 and an individual not more than $25,520.) But they are available only on silver plans. If you think you may qualify, look carefully at costs for the 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.
For more information, see Ways to Save Money on Obamacare in Texas.
3. You won’t face a tax penalty for going without health insurance in 2021—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 hard 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 would. (A study published in 2019 showed that a lapse in health insurance coverage can double a person's chances of ending up in bankruptcy.)
4. Watch out for insurance plans that don’t comply with the ACA.
In 2018, the Trump administration made it easier to purchase "short-term insurance plans." 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.
5. You can get help signing up if you need it.
The Biden administration is greatly increasing enrollment assistance plans, 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.