Main menu


What type of health insurance marketplace does Texas operate?

What type of health insurance marketplace does Texas operate?

Health insurance marketplace in the Texas

Texas uses the federally operated exchange at, and the state has adopted a laissez-faire approach to implementing the ACA. Texas has not expanded Medicaid and is one of three states to leave the rate review process for ACA-compliant plans to a CMS. (The state also reviews submissions to make sure they comply with Texas law.)

But the Texas Department of Insurance has a website called Texas Health Options, which provides resources and information for Texans looking for health insurance or who have questions about health insurance plans, costs, and quality comparisons.

Texas is also leading a lawsuit by 18 states challenging the legality of anti-corruption law now that the sanction for individual delegation has been lifted. The oral arguments of the case were heard by the Supreme Court in November 2020; A trial is expected in mid-2021.

But Texas also has one of the highest exchange registration rates in the country, with 1,284,524 people signing up for private plans through the Texas Stock Exchange during the open registration period to cover 2021. The state has a very large population. large, many of which were uninsured. They before the ACA. Only two states, Florida and California, have higher enrollment in their exchanges (without medical assistance) than Texas. And Texas is one of the few states on where enrollment increased from 2019 to 2020 (it increased again for 2021, although this was true for most states).

Prices rose sharply in 2018 and insurers began adding the cost of cost-sharing reductions (CSR) to Silver plan rates, resulting in an especially large premium subsidy (which is based on the cost of the plans Silver) in 2018. However, the average rate increase was more modest, exceeding 2%. By 2020, average rates have decreased slightly, although they are more than the national average for 2021. The cost of corporate social responsibility still adds to Plan Plata prices, so subsidies remain disproportionately large in Texas.

According to data from the US Census Bureau, Texas had the highest rate of uninsured people in the country in 2013, at 22.1 percent. And while the state's 18.4 percent uninsured rate in 2019 was still the highest in the country, a large number of Texans have had health coverage since the anti-corruption law was implemented. However, the number of people who would get coverage would be much higher if Texas accepted federal funding for Medicaid expansion under the ACA.

When was open enrollment for 2021 health insurance in Texas?

Open enrollment for 2021 health plans began in Texas from November 1 through December 15, 2020. Outside of that period, residents need eligible events to register or make changes to their coverage. Loss of other minimum essential coverage is a qualifying event, so people who lose employer-sponsored coverage as a result of the COVID-19 pandemic can register for a new plan in the single market, even if they lose coverage outside. of the open registration period.

What insurance companies offer coverage in the Texas marketplace?

As of 2020, there were eight insurance companies offering exchange plans in Texas, as well as two offering only individual OTC market plans that were ACA compliant. By 2021, there are ten insurers offering plans on the exchange: Friday Health Plan joined the market in Texas in the Austin, Dallas, El Paso, Houston, Lubbock and San Antonio regions. Scott & White Health Plan, which only introduced OTC plans in 2020, has joined the stock exchange in several counties in the Waco Austin regions. So for the year 2021, there are exchange plans available from the following insurance companies, but with plan availability, it varies from site to site:

  1. Celtic/Ambetter (Ambetter from Superior Health Plan)
  2. Blue Cross Blue Shield of Texas
  4. Friday Health Plan
  5. Molina
  6. Oscar
  7. Sendero 
  8. SHA/FirstCare
  9. Community Health Choice
  10. Scott & White Health Plan

Friday's health plans, which are based in Colorado, have also expanded to Nevada and New Mexico by 2021.