Texas Health Insurance Marketplace Agents

Call 512-963-5000 for all your options inside and outside of the Marketplace


BLUE CROSS BLUE SHIELD (BCBS) exchanges rates here…..

A health insurance Marketplace is a new marketplace for buying insurance in Texas. In 2014, every state will have an Marketplace that will organize plans and make them transparent so you know what benefits are covered and at what cost. In addition, middle-income families (less than $92,000 for a family of 4) without another source of insurance may be eligible for tax credits to help pay the cost of coverage.

One of the most important issues to be decided in the states is who will govern the Marketplace. The governing board will have the ability to direct all the future decisions of the Marketplace. HCAN and our state partners urge states to establish governing boards with strong consumer representation and to prohibit the participation of anyone who will benefit financially from the decisions of the Marketplace, like representatives of insurance companies or insurance agents and brokers.

Each state must have a Marketplace ready to offer coverage by January 1, 2014. HHS will evaluate states’ progress in January 2013 and begin to set-up a federally-facilitated Marketplace for states that aren’t on target to meet the 2014 deadline.

To date, 13 states and the District of Columbia have passed a law or have executive authority to establish an Exchange:

  • California
  • Colorado
  • Connecticut
  • Washington, D.C.
  • Hawaii
  • Maryland
  • Massachusetts
  • Nevada
  • Oregon
  • Rhode Island
  • Utah
  • Vermont
  • Washington
  • West Virginia

Agents Will Be Part of Health Care Reform & My Advice is Still FREE

Many of you have expressed concern about my role as your Agent in the new health insurance landscape, and I thank you for your kind thoughts. You may have heard in the news that the government was trying to replace Health Insurance Agents with non-licensed, non-insured and in-experienced “navigators” and “application assisters” whom will be paid by the government and have just 20 hours of training. The government has now realized they cannot successfully implement this extremely complicated law without agents, and they will be allowing licensed agents to participate in the enrollment process for millions of Americans. Remember, you get an agent’s advice for FREE today, and you will continue to get my advice for FREE in 2013 and beyond. Health insurance premiums are the same whether you buy directly from the insurance company, through the new health exchange, or you buy the same plan through an agent. My entire business will be turned upside down in the last quarter of this year, and my family and I are relying upon my existing/past clients to recognize the great service and advice I’ve given to you over the years, and that you will hopefully remain a client. I will also be relying upon your referrals of family & friends in the coming months. Many agents will not be able to manage the new landscape, but I plan to be one of the survivors! And remember…… friends don’t let friends get bad advice from a “navigator”.

Pre-existing Conditions and Lower Income
Anyone that you know that could not get health insurance before due to a pre-existing medical condition will now be able to get coverage starting Jan 1st 2014, no matter what the condition or current status of that condition. For those that you know that could not afford health insurance before, there will be subsidies available to help them secure coverage, see subsidy calculator and Federal Poverty Levels below. Please forward this email to your friends/family that you feel might benefit from my guidance. For those that decide not to buy health insurance, the penalty will be 1% of your income in 2014, and 2% in 2015.

What’s Happening Now?

Will the government be ready? There is great speculation that the government will not be ready to open the new federally-run state health exchanges in Texas in time for the launch date of October 1st, 2013 as the government is in charge of managing about 30 state health exchanges. I believe they will roll out in time, but they may be fraught with problems and technical issues. So, be patient as we go through the process later this year.

Which insurance companies are participating? Insurance companies are currently submitting their health plans and rates, with approvals from the federal government by late July. So far, many insurance companies are deciding to NOT participate in the new health insurance exchanges due to the onerous rules and regulations associated with the law. So, I expect there are going to be only a couple/few insurance companies and plan choices available in most states. But, in Texas, we will continue to have vibrant competitive markets due to the lower cost of health care delivery in our states, with only 1-3 insurers dropping out of the market. One example is that AARP has decided to no longer offer their product offering with Aetna in all 50 states, and have decided to not participate in Obamacare. Assurant Health will also not be participating in any health exchanges, but will be participating off the exchanges in the private market. See more info below on what will happen to your plan with AARP Aetna and Assurant. Cigna has announced they will only participate in 5 states, with AZ and FL being two of those states. Aetna, Goldenrule/UnitedHealth, Humana have yet to announce which states they will “play in”, and Blue Cross seems to be participating in every state.

What’s Going to Happen to My Current Plan?
There are two types of health insurance policies that exist in today’s market. You either own a “grandfathered” policy or a “non-grandfathered” policy.

Grandfathered policies were effective BEFORE 3/23/2010 when it was signed into law. ALL insurance companies will allow you to continue to own your grandfathered policy, regardless of whether or not they plan on participating in Obamacare going forward. For those clients that still own a grandfathered policy, the policy will NOT be required to conform to the new mandates in the law. It is VERY important that we speak before cancelling/changing your policy as your rates in 2014 could skyrocket under Obamacare if your have HIGHER income. Whether to keep your Grandfathered plan or not depends on your personal situation, current cost, projected 2014 income, current riders/exclusions and your health.

NON-Grandfathered policies are those that were effective AFTER 3/24/2010, and are required to change to conform to the new law at some point in the near future, and no later than 12/31/2014. BUT, the government is allowing them to push off the changes (more benefits / higher premiums) until your “renewal month” which is the month you bought your policy, or the month that you typically receive your annual rate increase. This is called the renewal “loophole”. Each insurance company has a team of lawyers, and each company is reading this section of the law differently and employing different strategies to push off any rate increases that you might experience. Some states are implementing laws not allowing this rate increase deferral (CA, OR, IL), but Texas is allowing companies to manage their clients within the parameters of the law. Rates will be rising due to the extra cost associated with rising health insurance taxes, exchange fees, guarantee issue risk pools to cover everyone’s pre-existing conditions, 3 to 1 age bands meaning they can’t charge a 64 yr old more than 3X a 21 yr old, required lower deductibles and out of pocket maximums to not exceed $6400 per person / $12,800 family, and additional benefits on all policies like maternity and mental health.

Here is a list of each company, or how they will be playing the “renewal” loophole for NON GRANDFATHERED (GF) policies:

Goldenrule/United Health Care: Will be resetting your renewal month in Dec 2013, with a December renewal date. While you will get a small rate increase at that time, your plan and rate will stay the same until Dec 2014, and therefore avoid the rate spike associated with all the new mandates listed above.
AARP / Aetna: All Non Grandfathered policies will be converted to a similar Aetna policy on Jan 1st, 2014 with a very little change in price. You will be able to keep that new Aetna plan and price until Dec 2014.
Aetna Direct: Even though they have not communicated, I’m getting indication that they will be doing the same as Goldenrule/United Health Care above.
Cigna: Same as United Health Care/Goldenrule above
Humana: No word yet on their renewal strategy.
BCBS of Texas: Will be conforming to Obamacare mandates on your anniversary renewal date/month. For those of you who own a NON grandfathered policy and have an early renewal date of January – August/Sept, it might be in your best interest to consider moving to another company to delay the rate shock until the end of 2014. Which company will depend upon your situation. Call me to discuss.
BCBS of Texas – All Non GF policies will be conforming in July 2014, you should consider moving to another company to delay higher premiums until Dec 2014.
ASSURANT HEALTHRATE LOCK UNTIL 12/2014 for new plans – for all plans purchased since last month (4/1/2013), you will be able to keep your plan and your price will not change until 12/2014. This is the best solution in the market at the current moment. Call me if you have high income above 400% FPL (see below), and you own a non grandfathered policy. All current Assurant owners who have a policy dated before 4/1/13, will have to conform to the new mandates in your renewal month next year.

Group / Employer health plans: There is great speculation that many smaller companies (under 50 employees) will be dropping their group plans and allowing their employees to get subsidies on the exchange. These employers under 50 will not have to pay a penalty, and you are already seeing a number of them reducing to under 30 hours to avoid being counted as a full time employee, or laying off staff to get under 50 full time employees. So, don’t be surprised if your employer drops your coverage, but also know that it may be in your best interest so that your whole family get the fullest subsidies on the exchange. If you hear that your employer will be doing so, please let me know as I’ll be able to assist each of the employees secure the best coverage with the most subsidies possible.

Open Enrollment is Quickly Approaching / Subsidies Available

Subsidies will be available for those Adjusted Gross Income (AGI) income levels (line 37 of your 1040 tax form) that fall BELOW 400% federal poverty level. Depending on your income level, you will be paying a certain percentage of your income in premiums. This will be based on your PROJECTED 2014 income, not 2012 or 2013.

400% of Federal Poverty Level (FPL)

  • Family of 1: Below-$44,680
  • Family of 2: Below-$60,520
  • Family of 3: Below-$76,360
  • Family of 4: Below-$92,200
  • Family of 5: Below-$108,040
  • Family of 6: Below-$123,880
  • Family of 7: Below-$139,720

Maximum premium as % of your income

  • 100% of FPL = 2% of AGI
  • 133% of FPL = 3% of AGI
  • 150% of FPL = 4% of AGI
  • 200% of FPL = 6.3% of AGI
  • 250% of FPL = 8.1% of AGI
  • 300% of FPL = 9.5% of AGI
  • 400% of FPL = 9.5% of AGI
  • (No subsidies above 400% FPL)

Here is a subsidy calculator to assist in running subsidy amounts and premium projections: National Health Care Calculator

WARNING: If you accept the premium subsidies / Tax credits, and your income comes in HIGHER in 2014 than you originally projected, the government can “clawback” a portion or all of your subsidies when you file your taxes, and you may end up owing the government at the end of the year. The same in reverse, if your income is lower than you projected, you will get a tax refund. Subsidies are ONLY available if you buy a plan ON the exchange.

ATTENTION TOBACCO USERS: if you’re going to quit, now is the time. Obamacare can only raise your rates for one reason, and that’s tobacco use. The surcharge is a whopping 50%, and it is not eligible to be subsidized. You can expect to pay $100 extra a month for a 21 yr old, and $400 extra per month for a 60+ yr old.
State Health Exchanges and New Plans Available
Each state health exchange will offer 4 different kinds of plans (Platinum, Gold, Silver & Bronze) from EACH insurance company that wants to offer health insurance. Each of the 4 plans are mandated to cover the 10 essential health benefit categories including preventative health, maternity, mental health, Rx, hospital, surgery, doctors, emergency, labs, and other outpatient items. Platinum plans will cost the most, and cover 90% of your out of pocket costs. Gold plans will pay 80%, silver plans will pay 70%, and bronze plans will pay 60%. The cost of the insurance is less as you go down the metal plan ladder (Bronze will be the cheapest). All plans are projected to have $1000-$5000 deductibles, with an out of pocket maximum of $6400 for an individual, and $12,800 for families.