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Is It Required To Have Health Insurance In Texas

The Future Of Individual Health Insurance Mandates

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Over the past year, a few additional states have considered or are considering individual mandates, including:

  • Connecticut
  • Washington

However, so far, none of these states havemanaged to ultimately pass state individual mandates.

Lawmakers who push for individual mandate laws argue that its needed to incentivize people to get health insurance. The argument is that if not enough healthy people sign up for coverage, the pool of insured individuals will be made up mostly of sick people, and health premiums will rise for everyone. However, many states have attempted and failed to pass individual mandate legislation, and these laws remain politically controversial.

According to Forbes.com, the new Biden administration is expected to bring back the federal tax penalty for going without ACA-compliant health coverage. Its unclear yet whether he would do this through an executive order or legislative reform. Find out more on if it is okay to be uninsured.

How Does The Irs Know If You Have Health Insurance

Health insurers, employers that sponsor health plans and agencies that administer government health plans will file annual reports to the IRS about who is covered under their plans. When you file your tax return for the previous year, you will report whether you and your family members had health insurance coverage.

Cheapest Health Insurance Coverage By Plan Tier

The average cost of a Silver health insurance plan in Texas for a 40-year-old is $575 per month, which is a 13% increase over last year.

To help you get started finding the best health insurance plan available for your preferred level of coverage, we compared Texas policies by plan tier and identified the cheapest health insurance option available in the state.

Plan tier
Blue Advantage Bronze HMO, 301 $323

Costs are for a 40-year-old.

The set of insurers and health plans varies by county, so not all of those listed above are available in every region. We recommend using these as a starting point to assess the monthly premiums you can expect as compared to benefits and out-of-pocket expenses.

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Potential Impact Of California V Texas Decision On Key Provisions Of The Affordable Care Act

The Supreme Court will review the constitutionality of the Affordable Care Act this November in California v. Texas . Late last year, a federal appeals court panel ruled that the ACAs individual mandate is unconstitutional, since Congress has set the mandate tax penalty to zero. The case was brought by a number of Republican state officials and two individuals, who argue that the rest of the ACA is not severable from the mandate and should therefore be invalidated. The Trump administration now argues that nearly all of the ACA should be found invalid but that the courts should prohibit it from enforcing only the provisions found to harm the individual plaintiffs. It previously argued that only the ACAs pre-existing condition protections should be overturned.1 Pending a final decision on the case, the Trump administration has continued to enforce the ACA.

The following table summarizes the major provisions of the ACA, illustrating the breadth of its changes to the health care system, and public attitudes towards those changes. If all or most of the ACA is struck down, many of these provisions could be eliminated.

Browse Key Provisions by Category:

Texas Has The Most People Without Health Insurance In The Nation Again

Texas Health Care Insurance

For the second year in a row, the number of Texans without health insurance increased, and fewer people enrolled in Medicaid.

*Correction appended

The rate of Texans without health insurance rose for the second year in a row, making it once again the most uninsured state in the nation, according to data released Tuesday by the U.S. Census Bureau.

In 2018, 17.7% of Texas residents about 5 million people had no health coverage, up from 17.3% in 2017. Both years, Texas had almost double the number of uninsured people compared with the national average of 8.7% in 2017 and 8.9% in 2018. It was one of only nine states to record an increase in the uninsured rate.

Texas is one of 14 states that have not expanded Medicaid, a joint state-federal program that provides health care to low-income individuals, since the 2010 passage of the Affordable Care Act better known as Obamacare. President Donald Trump made the repeal and replacement of Obamacare a major part of his 2016 campaign, but the U.S. Senate narrowly rejected a bill in 2017 that would have repealed parts of the ACA.

Last year, a federal judge in Texas invalidated Obamacare, although the law remains in effect pending an appeal.

Expanding Medicaid would have filled coverage gaps for an estimated 1.1 million low-income Texans, according to the Kaiser Family Foundation. Between 2017 and 2018, fewer Texans got their insurance through Medicaid the number dropped 0.7%, to 17.9%.

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Are My Parents Required To Claim Me As A Dependent

You must be under the age of 19 for your parents to claim you as a dependent. However, if you are a full-time student, you must be under age 24 in order for your parents to claim you as a dependent. If you are totally and permanently disabled, there is no age limit for your parents to claim you as a dependent.

Texas Available Standardized Plans

To help you more easily compare costs and benefits, ACA designates that all qualifying plans be one of four metals: Bronze, Silver, Gold and Platinum. Each is based on the average amount of healthcare costs the plan will cover shown as a percentage of what is covered by your insurance company and what is paid for by you. All insurers participating in the federal or a state healthcare exchange must offer, at minimum, Silver and Gold plans. All metal plans have a shared maximum out-of-pocket amount that you can be charged in any calendar year.

Metal Plan
90% 10%

In addition, if you are under 30 or meet the criteria for a hardship exemption, you can purchase a catastrophic plan that is compliant with ACA requirements.

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Health Insurance Coverage For Multiple Years

TriTerm Medical Insurance,4 underwritten by Golden Rule Insurance Company, is short term health insurance that offers coverage for preventive care, doctor office visits, and prescriptions.

  • Apply once for insurance coverage terms that equal one day less than 3 years.
  • $2 million lifetime maximum benefit per covered person on most plans.
  • Eligible expenses for preexisting conditions are covered after 12 months on the plan.

Questions about Short Term or TriTerm Medical insurance? Call / TTY 711 to talk to a representative.

The Medical Support Order

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Cash medical expenses which go by unreimbursed are a reality with children, even if you have medical insurance.

However, when it comes to divorce and health insurance proceedings, courts in the state of Texas will include these medical costs in child support orders.

Each parent may be expected to share these expenses equally, depending on respective incomes. If one parent earns more than the other, they may be expected to front the majority of these payments.

During the discussion of your divorce and health insurance proceedings, a set figure will generally be established in your medical support order.

This amount must be paid in advance, so the funds are available if your child need them.

Essentially, the medical support order is akin to paying a second child support order.

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Challenging A Child Support Order Amount

Once a guideline amount for child support is presented to the court, it can be challenged before the court issues the order.

If the guideline amount appears unfair e.g. too low or too high for the parent to pay, you can ask the court to review it.

The court will then take into the account the following factors when deciding whether to adjust a child support amount:

  • The age of your child
  • Your ability to support your child
  • Your financial income and existing debt
  • The custodial parents income and resources
  • Childcare costs
  • Additional employment benefits for both parents
  • Other alimony payments
  • Health insurance provisions for each child
  • Educational expenses

Do I Have To Report Health Insurance On My Taxes

You no longer need to report health insurance coverage for the tax year unless you or a family member were enrolled in health insurance through the Marketplace and advance payments of the Premium Tax Credit were made to your insurance company to reduce your monthly premium payment. Start Your 2021 Tax Return Now!.

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What Qualifies As Minimum Essential Coverage

The Affordable Care Act requires you to have whats called minimum essential coverage or MEC. The following types of health coverage meet the ACAs guidelines:

  • any health plan bought through Healthcare.gov
  • individual health plans purchased outside Healthcare.gov, if they meet the standards for qualified health plans
  • any grandfathered individual insurance plan youve had since March 23, 2010, or earlier
  • any job-based plan, including retiree plans and COBRA coverage
  • Medicare Part A or Part C
  • most Medicaid coverage, except for limited coverage plans
  • coverage under the Childrens Health Insurance Program
  • coverage under a parents plan
  • most student health plans
  • health coverage for Peace Corps volunteers
  • certain types of veterans health coverage through the Department of Veterans Affairsmost TRICARE plans

Is It Illegal To Go Without Health Insurance

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The federal government no longer requires individuals to have health insurance. However, a handful of states and the District of Columbia have instituted a health insurance coverage mandate, and most carry a penalty for not doing so. If you live in California, Massachusetts, New Jersey, Rhode Island, or Washington, D.C., you must have insurance or pay a penalty. Vermonts mandate does not include a penalty for noncompliance.

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Insurance For Individuals In Texas

When selecting a plan, you can choose from several different options for the network of doctors you have access to and how you receive the health care.

  • A health maintenance organization plan is less expensive than other types of plans but has stricter rules about accessing health care. You can only use that plans in-network health providers, youll need to obtain referrals when you want to see a specialist, and youll be preassigned a primary care provider.
  • A preferred provider organization plan offers more flexibility, but youll pay a bit more for nationwide access to doctors and hospitals. A PPO has a higher monthly premium but allows you to use both in-network and out-of-network health care providers in-network providers will have a far lower cost. If you have a chronic health condition, this is a good plan to investigate. Other benefits include no referrals to see a specialist, and you can choose any primary care provider.
  • A point of service plan takes a little bit from an HMO and a little bit from a PPO. You can use an out-of-network provider, which is helpful if you have a chronic condition and have a preferred provider. Youll still need to get a referral to see any specialist.

Health Marketplace: Buying Your Own Health Insurance

Insurance you buy from a company or the marketplace is individual insurance. Itâs sold to individuals, not to members of a certain group.

You can buy individual coverage through:

  • An insurance company or health maintenance organization
  • A licensed health insurance agent who has a relationship with one or more insurance companies
  • Healthcare.gov, the online federal health insurance Marketplace
  • Theâ¯Plan Finderâ¯on Healthcare.gov for individuals and small businesses
  • Aâ¯Navigatorâ¯approved to help with Marketplace enrollment

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Eligibility: How Am I Evaluated By Health Insurance Companies

Each private health insurance company has the flexibility to create their own rules regarding which applicants will be accepted for an individual health insurance policy in Texas. Additionally, an applicant can be turned down by in insurance provider for any reason. The only exception to this is for newborns who are required to be covered under their parents policy for the first 30 days and disabled, dependent children whose parents have a policy that covers dependents. Although private insurance in the state is not guarantee issue, to comply with HIPAA Group-to-Individual Portability Coverage regulations, the state does guarantee acceptance into the Texas Health Insurance Risk Pool , for those who are HIPAA eligible but have been unable to obtain coverage through a private insurer.

Bronze And Catastrophic Plans Are Best For The Young And Healthy

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The cheapest health insurance options are Bronze and Catastrophic plans. These plans, while having low monthly premiums, come with high out-of-pocket costs, often with deductibles and out-of-pocket maximums near the highest amount allowable by law. For 2022, this is $8,700 for an individual and $17,400 for a household.

You might find lower premiums very appealing, but these plans will generally cover nothing until youve paid thousands of dollars in bills first.

This could be problematic if you dont have any disposable savings if you find yourself in need of moderate medical care. In such cases, you would effectively pay for the costs yourself. The Bronze and Catastrophic plans really help out in cases of significant emergencies where care will cost tens or hundreds of thousands of dollars.

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How Much Does Health Insurance Cost In Texas

The Texas health insurance marketplace offers plans that work on the metal tier system: Bronze, Silver, Gold, and Platinum. Every tier provides ACA-compliant coverage but differs in the percentage of coinsurance and deductibles, which dictate your out-of-pocket costs. Some have higher premiums some have higher deductibles. Consider a balance of an affordable monthly premium offset against your out-of-pocket expenses when you visit the doctor or have a catastrophic event.

Average premiums in Texas
$429 $403
  • Bronze plans are for people with few health concerns or limited financial resources. The plans offer low monthly premiums but a high deductible. Theres also a 40% coinsurance payment for a doctors visit or other medical services. The most affordable Bronze plan in 2022 in Texas costs $306 a month.
  • Youll pay a higher monthly premium for a Silver plan, but youll also have fewer out-of-pocket costs. The coinsurance fees drop to 30%. Silver plans offer cost-sharing reductions . If you qualify for a CSR, you may pay less for a Silver plan than you would for a Bronze plan. The most affordable Silver plan in Texas costs $415 a month.
  • gold or platinum plan. These plans offer the lowest deductibles and coinsurance payments . However, be prepared to pay heftier monthly premiums. The most affordable gold plan in Texas goes four $429 a month.

Is It Worth Going Without Health Insurance In Texas

As briefly noted above, there is no tax penalty for going without health insurance in Texas. But is it really worth it? Believe it or not, a medical crisis can leave you in a very precarious situation financially and can do more damage than the tax penalty would.

Whether or not youâve been feeling discouraged by the rising health insurance costs including the premiums, copays, and deductibles, there are very compelling reasons why you should always stay covered.

According to data published by the American Bankruptcy Institute Law Review, Americans are twice as likely to file for bankruptcy if they go without health insurance or let it lapse for two years. A study by the Kaiser Family Foundation also stipulates that almost 50% of Americans say that they or a family member is uninsured because of the rising costs of health insurance.

But even with that, many Americans get very worried about whether or not they would be able to afford unexpected medical bills without health insurance. If anything, many Americans are more worried about affording health costs than any other thing in their lives.

The table below shows the cost-related features that are most important to Americans and how worried or concerned Americans are about affording these costs.

But because your peace of mind is of great importance and you do not want to be worried about whether or not you could be able to afford unexpected medical bills, itâs important to get health insurance in Texas.

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How To Get Enrolled

Whether you live in a state with an individual mandate or not, you can get the coverage you need during Open Enrollment. The annual Open Enrollment Period is the time when all eligible Americans can shop the Health Insurance Marketplace. There, you can pick an Affordable Care Act-compliant health plan for 2020. Getting an Obamacare health insurance plan means knows you are getting care that meets certain standards. And this is in terms of both level of coverage and consumer protections. Also, when you shop the Marketplace for health insurance, youll also see what kinds of subsidies you qualify for to make that coverage more affordable. These subsidies are based on household income, and they can be very significantpeople who enroll on HealthSherpa pay an average of $47/month, and 94% of people qualified for subsidies during 2020s Open Enrollment. You can also see if you qualify for Medicaid or Medicare on HealthSherpa.

Ready to get started? Shopping the Marketplace with HealthSherpa is streamlined and straightforward. Plus our Consumer Advocate Team is on-hand to help each step along the way at .

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