If you live in Austin and buy your own health insurance, you shop on HealthCare.gov, and you do not have to sort it out alone. Texas does not run its own exchange, so private Marketplace plans and the premium tax credit come through HealthCare.gov whether you live downtown, in Round Rock, Cedar Park, Pflugerville, Georgetown, Leander, Manor, Kyle, Buda, or San Marcos.
This article is educational. Instant Health Help is a licensed health insurance agency, and our agent, Lobsang Rivas, is licensed in Texas. We are not HealthCare.gov, CMS, Texas Health and Human Services, or an insurance company. We do not quote prices or name plans here, and what you qualify for depends on your income, household, and ZIP code. Check the official dates on HealthCare.gov.
The short answer
- Open enrollment runs November 1 to January 15. Choose a plan by December 15 for coverage starting January 1. Enroll December 16 to January 15 and coverage starts February 1.
- Texas Medicaid and CHIP are a separate door. They are run by Texas Health and Human Services, and you can apply with the state through Your Texas Benefits.
- Your savings are based on what you expect to earn next year, not last year.
For the full step by step walkthrough, read our Texas open enrollment guide. Here we focus on what we hear most from people around Austin.
Who in Austin usually needs help
Freelancers, creatives, and contract tech workers. Austin has a lot of people who work for themselves or bill by the project, so income can swing from month to month. Use your recent tax return and this year’s numbers to make a careful estimate for next year. If your income goes up during the year, report it right away. There is no longer a cap on how much extra premium credit you may have to pay back.
People who just moved to Central Texas. HealthCare.gov says moving to a new home in a new ZIP code or county may qualify you for a Special Enrollment Period, so you do not always have to wait for November. Plans are sold by area, so the choices you had in your old state or city will not carry over. If you came from a state that runs its own marketplace, you will apply on HealthCare.gov now.
Workers at startups and small companies. Some employers offer money toward an individual plan instead of a group plan. If your employer offers a CHOICE Arrangement (formerly called an ICHRA), it can affect whether you qualify for Marketplace savings, so ask us to check. HealthCare.gov says a new offer like this may open a Special Enrollment Period, and you finish that enrollment by calling the Marketplace Call Center.
Students and recent grads. Between the universities and the community college, Austin has a lot of young adults. HealthCare.gov says you can usually stay on a parent’s plan until you turn 26, and losing that coverage, or losing eligibility for a student health plan, can qualify you for a Special Enrollment Period.
How the savings work
Premium tax credits are generally available to households earning between 100% and 400% of the federal poverty level. Above 400%, the credit generally isn’t available. Extra savings on deductibles and copays, called cost-sharing reductions, come only with Silver plans, for incomes up to 250% of the poverty level.
If you like to save for medical costs on your own, every Marketplace Bronze and Catastrophic plan now works with a Health Savings Account (HSA). Catastrophic plans are for people under 30 or those who qualify for a hardship exemption. They include at least 3 primary care visits before the deductible, but they aren’t eligible for premium tax credits.
Marketplace or Texas Medicaid and CHIP?
Texas Health and Human Services says Medicaid and CHIP mainly help low-income children and families, and Medicaid also serves some pregnant women, seniors, and people with disabilities. If your household income is lower, especially if you have kids at home, check Medicaid and CHIP first. HealthCare.gov also suggests filling out a Marketplace application even if your income looks too low, because the application can show what you or your kids may qualify for.
Doctors and hospitals
If you want to keep a doctor at a hospital campus near downtown or in North Austin, or at a clinic in Round Rock, Cedar Park, or Kyle, write their names down before you compare plans. Each plan has its own network, so confirm with the plan and the office before you enroll.
What to gather before November 1
- Names and birth dates for everyone on your tax return.
- Your household income estimate for next year.
- Your current HealthCare.gov login, if you have one.
- Details of any employer offer, including a CHOICE Arrangement.
- Your doctors and prescriptions.
When you work with an agent, you will get a text or email asking you to approve that agent. Only approve someone you chose, and never share your HealthCare.gov login. A licensed agent doesn’t need it.
How we help
We help Texas residents by phone and online, in English or Spanish. See our Texas health insurance help page. We go over who needs coverage, your ZIP code, your income estimate, any employer offer, your doctors, and your prescriptions, then walk through the HealthCare.gov application with you.
Ready when you are
Have your income estimate and your doctor list handy, and we will take it one step at a time.
Call (321) 315-0054 | agent@inshh.com
You may qualify after tax credits. Eligibility varies.
Featured photo: Pennybacker Bridge by Ramir Borja, CC BY-SA 2.5, cropped with text added.
