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Is the Federal Health Insurance Marketplace a Better Option for You?

The Federal Health Insurance Marketplace provides people an alternative to costly private insurance companies and employer-provided insurance. Short term insurance and health savings accounts are existing options that must now compete with plans on the Federal Health Insurance Marketplace. Low income earners can qualify for a lower premium and lower out-of-pocket costs. Also, there are options that make it more affordable to include family members in your insurance plan.

An Alternative to Expensive Private Insurance and Employer-Provided Insurance

If you have less and less money to spend each month, consider lowering your health insurance expenses. Most private insurance providers and employer-provided insurer maintain rates and may even increase them in the years to come. This might be a much larger portion of your income and create a unnecessary burden. Consider shopping for health insurance plans that are competitively priced on the Federal Health Insurance Marketplace. There are several options that may lower your health insurance costs by providing the following:

-Free Preventive Care
-Affordable Prescription Drug Coverage
-Affordable Checkups
-Affordable Pre-natal Care
-Affordable Emergency Care Coverage

The plans vary by coverages and the amount charged for premiums. If you are healthy, select a plan with a low monthly premium, while those that need more medical treatments and medications should select a plan that covers this cost with a higher monthly premium.

The Federal Health Insurance Marketplace Provides Tax Credits for Low Income Earners

If your employer doesn’t provide health insurance or you can’t afford it, consider taking advantage of the tax credits offered through the Federal Health Insurance Marketplace. Purchase a plan here and receive tax credits to subsidize the cost. The subsidies are based on household income and household size. For a family of four, if the annual household income is between $23,850 and $95,400, a tax credit is available. Out-of-pocket expenses are subsidized as well if the family of four earns less than $59,625. Consult this chart to see if you qualify for subsidized healthcare: Incomes that qualify for lower costs.

Guaranteed Coverages Provided by Federal Health Insurance Marketplace Plans

Unlike some employee-provided insurance and private insurance, all plans in the Federal Health Insurance Marketplace offer 10 essential benefits including:

-Outpatient care including ambulatory patient services after admission to hospital
-Emergency care
-Surgery and other hospital procedures
-Pregnancy, maternity, and newborn care
-Mental health and substance use disorder services
-Prescription drugs
-Rehab and devices for those with injuries, disabilities, or chronic conditions recover mentally and physically
-Lab tests
-Preventive and wellness services and chronic disease management
-Pediatric services

These essential coverages are supplemented with more coverages and vary depending on the specific health plan you select. The insurance plans offered through the Federal Healthcare Marketplace don’t discriminate against those with pre-existing conditions.

Short Term Insurance and Health Insurance Accounts (HSAs) are Still Available

Short term health plans are available to keep people insured until the next enrollment period. These are generally cheaper and are perfect for individuals without pre-existing conditions. Individuals with short-term health plans are subject to the tax penalty, just like the uninsured.

HSAs are still available, although there are a few changes due to the Affordable Care Act. Only prescribed medicines, including OTC drugs, and insulin, whether purchased with a prescription or not, will be considered qualifying medical expenses. Another change is the penalty for withdrawing funds from HSAs before age 65 for unqualified expenses. It is now 20% instead of 10%, and the funds are considered taxable income. Individuals with HSAs aren’t subject to the uninsured tax penalty.

HSAs can be combined with an ACA-compliant plan that has a high deductible. These ACA-compliant plans cover 60% of expenses and are labeled Bronze plans in the health insurance marketplace. There are four levels of coverage to choose from:

Bronze: 60% Coverage
Silver: 70% Coverage
Gold: 80% Coverage
Platinum: 90% Coverage

Plan Preview and Price Estimator on the Marketplace

See exactly what your options are with the plan preview tool on the Healthcare Marketplace. The health plan premiums quoted here are estimates and give you an idea of the health insurance market in your area. Enter your zip code and household information including family size and income. After providing this information, an estimated eligibility result is generated which determines whether you are eligible for a tax credit for premiums and/or a cost-sharing reduction that reduces out-of-pocket expenses including deductibles, co-payments, and coinsurance. Afterward, a list of matching insurance plans are provided that include the monthly premium after tax credit, estimated deductible, and estimated out-of-pocket cost over a year.

Enroll Today

Enroll online via the Custom Health Plans portal. It is available to all Texas residents and includes access to a trusted advisor that will help them navigate through the health insurance landscape. Custom Health Plans provide a detailed description of the different types of health plans that are available. Get quotes, compare plans, and apply online. Submit applications between November 15 and December 15 to get a January 1 start date for medical coverage. If the application for health insurance is submitted after December 15, the effective coverage date is February 1. Custom Health Plans can help all Texas residents get affordable health care coverage.

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