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Texas Health Insurance Exchange Marketplace

Texas uses the federally run exchange at HealthCare.gov, and the state has taken a very hands-off approach concerning the implementation of the ACA. Texas has not expanded Medicaid and is one of just three states that leaves the rate review process for ACA-compliant plans to CMS. (The state does also review filings to ensure they are compliant with Texas law.)

Texas is also leading an 18-state lawsuit that challenges the legality of the Affordable Care Act now that the individual mandate penalty has been repealed. The Supreme Court will hear oral arguments in the case during the term that begins in the fall of 2020.

But Texas also has one of the highest exchange enrollments in the United States, with 1,116,293 persons enrolling in private plans through the Texas exchange during the open enrollment period for 2020 coverage. The state has many people, most of whom were uninsured pre-ACA. Only two states — Florida and California — have higher enrollment in their exchanges (not counting Medicaid) as compared to Texas. And Texas is among a handful of HealthCare.gov states where enrollment increased from 2019 to 2020.

Rates increased sharply in 2018, and health insurance companies started adding the cost of cost-sharing reductions (CSR) to silver plan rates, leading to particularly large premium subsidies (which are based on the cost of silver plans) in 2018. Nevertheless, for 2019, the average rate increase was much more modest, at just over 2 percent. And for 2020, average rates decreased to some extent. The cost of CSR is still being added to silver plan rates, so subsidies are still unreasonably large in Texas.

According to US Census Bureau data, Texas had the highest number of uninsured people in 2013 at 22.1 percent. And although the state’s 17.7 percent uninsured rate in 2018 was still the highest in the United States, a substantial number of Texas residents had obtained health coverage since the ACA was implemented. Nevertheless, the number of people gaining coverage would be far higher if Texas were to accept federal funding to expand Medicaid under the ACA.

Texas 2021 Health Insurance Open Enrollment

Open enrollment for 2021 health insurance plans in Texas will run from November 1, 2020, throughout December 15, 2020. Outside of that window, people need qualifying events to enroll or make changes to their coverage. Loss of other minimum essential coverage is a qualifying event, so individuals losing employer-sponsored coverage due to the COVID-19 pandemic are able to enroll in a new plan in the individual market, as long as they do so within 60 days of losing coverage.

Health Insurers That Offer 2020 Coverage in the Texas Marketplace

As of 2020, eight insurers offer exchange plans in Texas, plus two that provide ACA-compliant individual market plans only outside the exchange. For 2021, it is expected that there will be ten insurers providing plans in the exchange: Friday Health Plan will join the marketplace in Texas, and Scott & White Health Plan, which only provides plans outside the exchange in 2020, will join the exchange in north Texas.

As of 2021, health insurance exchange plans will be available from the following insurers, but with plan availability differing from one location to another:

• SHA/FirstCare
• Sendero
• Scott & White Health Plan
• Oscar
• Molina
• Friday Health Plan
• Community Health Choice
• CHRISTUS
• Celtic/Ambetter (Ambetter from Superior Health Plan)
• Blue Cross Blue Shield of Texas

Resources and References:

• Health Insurance Coverage
• The Affordable Care Act