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What Texans Need to Know About the Health Insurance Marketplace

Veronica Zaragovia, KUT News
Department of Health and Human Services Secretary Kathleen Sebelius promoted the health insurance marketplace under the Affordable Care Act during an Austin visit on Aug. 8, 2013.

About half of Americans say they don’t know how they and their families will be affected by the Affordable Care Act. That’s according to a Kaiser Health Tracking Poll done last month.

So what exactly do Texans need to know about the health insurance marketplace that launches next month?

"If I were uninsured and I was hearing all the news about the new health insurance that’s gonna be available Oct. 1,  I’d have some specific questions," said Bee Moorhead, executive director of the Texas Interfaith Center for Public Policy, also known as Texas Impact.

Moorhead's questions are in bold below:

Where can I get it?


What is the marketplace anyway?

For help with that one, I turned to Stacey Pogue, health policy analyst for the Center for Public Policy Priorities.

"So the marketplace is a new way to shop for health insurance starting Oct. 1," Pogue said. "People can go online and compare health plans from a variety of different private health insurance companies. The information will be understandable and clear."

Am I going to be able to afford it?

"Insurance plans on the new marketplace will be laid out in basic tiers: bronze, silver, gold and platinum," said Blake Hutson, a senior associate with ConsumersUnion. He’s an expert on health reform campaigns and insurance rate reviews.

"This simply means you may pay more for a platinum plan but in the event you get sick, you might not have as big of out of pocket costs like copays and deductibles," Hutson said. "If you feel like you don’t go to the doctor very often or you have a low risk of injury or illness, then you may want to purchase a plan that’s cheaper each month, like a bronze plan."

Depending on how many people in your family, and your household’s projected 2014 income, you could qualify for an automatic tax subsidy.

"Individuals who make from about $11,000 a year to about $46,000 a year, or if it’s a family of four making about $23,000 dollars a year to $94,000 a year -- there’s an income range for people who can get help with their insurance in the marketplace," Pogue said.

No one knows exactly how much the plans on the Texas marketplace will cost just yet. Because the state declined to set it up, the federal government is running the marketplace. The rates the feds have negotiated with insurance companies haven’t been released yet.

What exactly is covered?

"Every single plan is going to have what we call essential health benefits," Pogue said. "That core set of services that includes hospitalization, mental health, pediatric, vision and dental, emergency room, maternity."

The Oct. 1 opening of the marketplace only means people can get insurance there – they don’t have to. But come January, most people will need to have some kind of health insurance coverage or pay a penalty. 

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