The Health Insurance Marketplace
Beginning Oct 1, the Health Insurance Marketplace will make it easy for Texans to compare qualified health plans, get answers to questions, find out if they are eligible for lower costs for private insurance or health programs like
Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage.
New coverage options for young adults
Under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision, over 3 million young people who would otherwise have been uninsured have gained coverage nationwide, including 357,000 young adults in Texas.
Ending discrimination for pre-existing conditions
As many as 10,694,840 non-elderly Texans have some type of pre-existing health condition, including 1,632,475 children. Today, insurers can no longer deny coverage to children because of a pre-existing condition, like
asthma or diabetes, under the health care law. And beginning in 2014, health insurers will no longer be able to charge more or deny coverage to anyone because of a pre-existing condition. The health care law also established
a temporary health insurance program for individuals who were denied health insurance coverage because of a pre-existing condition. 9,592 Texans with pre-existing conditions have gained coverage through the Pre-Existing Condition Insurance Plan since the program began.
Health insurance marketplaces.
By Oct. 1, 2013, every state will have an insurance exchange—an organized marketplace where individuals and
small-business owners can select from among all the qualified private health plans available in their area.
Everyone will be required to have health insurance or pay a penalty. Almost any sort of legitimate coverage will satisfy the mandate: private insurance obtained on your own or through a job, Medicare, Medicaid, CHIP, Veterans Affairs, the Indian Health Service, or Tricare.
If you don’t have health insurance, you’ll have to pay a tax penalty, starting at $95 per individual, $285 per family, or 1 percent of income, whichever is greater, for 2014. (That rises to $695 per individual, $2,085 per family, or 2.5 percent of income in 2016.) Because the vast majority of people will already have qualifying health insurance, few will confront the choice of buying a plan or paying a penalty. Moreover, you won’t have to pay it if you make too little money to file a federal tax return or would have to spend more than 8 percent of your household income on the cheapest qualifying plan, even including subsidies. Americans living abroad, and those in prisons, are exempt from the mandate and associated fines.
The health care law was intended to expand the government-run health program for low-income Americans to cover up to 16 million more people with household incomes up to 133% of the poverty line ($14,856 for an individual and $30,657 for a family of four). That includes many at or below the poverty line who aren’t currently eligible. However, the decision on whether or not to expand Medicaid in this way was handed back to the states as part of the Supreme Court's 2012 ruling upholding the constitutionality of the health reform law as a whole. While many states have announced they will go ahead with the Medicaid expansion, others are still deciding and some have definitely turned down the expansion (although any state can change its mind at any time). In states that decline to expand Medicaid, households with incomes below the poverty line may be left without a source of health coverage. households between 100% and 133% of the poverty line will be allowed to purchase coverage, with significant subsidies, on their state's marketplace.