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Health Care Reform:

Health Insurance & Affordable Care Act

Texas Health Insurance Marketplace

Plans and Costs continued...

Your Choice of Health Care Provider: If you would like to keep your current doctor, check to make sure she's in the network you choose. You will pay either all or some of the cost of your health care if you choose a doctor outside the network.

Prescription Drug Coverage: If you take drugs for an ongoing condition, check the plan’s coinsurance and copayment requirements. Also check whether the drug is on the plan’s list of covered medications, called the formulary.

Your age: If you are under 30 and are in good health, you may want to consider a plan with a lower premium, such as a catastrophic plan.

Pre-existing conditions: If you need regular care, consider how many doctor and specialist visits and tests you may need.

Benefits

What’s Covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. They include:

  1. Outpatient services, such as doctor visits or tests done outside a hospital
  2. Emergency services
  3. Hospital stays
  4. Pregnancy and baby care
  5. Mental health and substance abuse services, including behavioral health treatment
  6. Prescription drugs, including generic and certain brand-name drugs
  7. Lab tests
  8. Rehabilitative services, such as those that help people recover from an accident or injury, and habilitative services, which help people with developmental issues.
  9. Preventive and wellness services, along with those that help people manage chronic conditions; these are covered at no additional cost.
  10. Services for children, including dental and eye care

 

Financial Aid and Medicaid

You may be eligible for financial aid to help pay for insurance or for government sponsored insurance, such as Medicaid or CHIP. Here’s what’s available:

Premium Subsidies (also known as Tax Credits ): You may qualify for a federal subsidy to help lower your monthly premium. The subsidy is available only if you buy your insurance in the Marketplace. In general, you'll be eligible if you're single and make between $11,670 and $46,680 a year, or if you have a family of four and make between $23,850 and $95,400 a year. Subsidies are based on your estimated household income for 2015. You can use your 2014 tax return to estimate your 2015 income. When you file taxes for 2015, the IRS will adjust your subsidy based on your actual income.

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