How to get Obamacare in Texas




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Premium Credit Table 2015 Enrollment


Under the Affordable Care Act, you may be able to get help paying for your monthly premium depending on your family size and income.  The amount of premium credit will depend on your family size and family income.  If your family makes less than the yearly income below, you may qualify.

Affordable Care Act

2014/2015 - Medicaid Kicks in at 100% BELOW the Federal Poverty Level (FPL)

 Affordable Care Act


Coverage Limits of the ACA


The Out Of Pocket (OOP) Maximum which includes the deductible for an individual is $6600 and for a family is $13,200.  All co-payments such as doctor’s office visits now go toward the OOP. For 2016 policies, the OOP maximum for an individual will be, $6850 and for a family will be $13,700.

During the 2015 enrollment, the maximum allowable payments to a HSA are $3350 for an individual and $6650 for a family. The family contribution increases by $100 to $6750 for the 2016 enrollment period

    The Ten Essential Health Benefits (EHBs) of the ACA


    1. - Hospitalization
    2. - Prescription Drugs
    3. - Emergency Services
    4. - Laboratory Services
    5. - Ambulatory Patient Services
    6. - Maternity and Newborn Care
    7. - Pediatric Dental and Vision Care
    8. - Rehab and Facilitative Services & Devices
    9. - Preventative, Wellness & Chronic Disease Management
    10. - Mental Health, Substance Abuse and Behavioral Health Treatment


    Other Mandates of the ACA


    1. - No annual or lifetime dollar limits on EHBs.
    2. - Adult children may remain on a parents plan until age 26.
    3. - Plans obtained before March 23rd, 2010 may be “Grandfathered Plans”. 


    Excluded Benefits


      1. - Non-pediatric dental services.
      2. - Routine non-pediatric eye exam services.
      3. - Long term custodial nursing home care.
      4. - Non-medically necessary orthodontia.
      5. - A plan is NOT required to cover abortion services.


      Open enrollment for individual health insurance is between October 1st through December 7th of each year.  If one of these “Qualifying Life Events” occurs between December 8th and September 30th, you or your dependent(s) will be eligible to enroll in a health plan, with your effective date no more than 60 days from the date of your "Qualifying Event".  This means if you wait until the 59th day to enroll after your "Qualifying Event", you will be able to recieve health insurance on the 1st of a month with at least a 15 day waiting period.

      Qualifying Life Events


        1. - I gained a dependent due to marriage.
        2. - I gained a dependent due to birth, adoption, or placement for adoption.
        3. - I am no longer eligible as a dependent under my prior health insurance due to reaching the maximum age, legal separation, divorce or death of policyholder.
        4. - I am no longer eligible for my prior health insurance plan due to termination of employment, reduction in number of hours of employment, loss of employer contribution toward my premiums, or I have exhausted my COBRA benefits.
        5. - I gained access to new health plan option because of a permanent move.
        6. - I am newly ineligible for payments of the advance premium tax credit.
        7. - I am no longer residing or living in my prior health insurance plan’s HMO service area.
        8. - I have adequately demonstrated that my previous health plan or issuer substantially violated a material provision of its contract with me.
        9. - I and/or my dependent(s) lost minimum essential coverage (Due to reasons other than non-payment of premiums or rescission.
        10. - Other qualifying events (as required or permitted by applicable laws).

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