By Olla Mokhtar and Edison Wu / The Texas Tribune
The annual window to sign up for health insurance through the Affordable Care Act opens Nov. 1, and many Texans are expected to pay more for coverage this year.
Enhanced premium tax credits that have helped ACA enrollees shave off the cost of their premiums are slated to expire at the end of the year. The loss of the subsidies will have an outsized effect on Texas, where nearly 4 million people signed up for ACA coverage this year. Policy experts fear that ratcheting up the cost of ACA coverage will make it so unaffordable that people will drop health insurance coverage altogether.
Additionally, funding for navigators, which helped 26,533 Texans sign up for ACA last year, has been reduced by 90% this year.
Texas has the highest uninsured rate in the country — 16.7% of the population did not have health insurance coverage in 2024, the latest data available. More than a 1 million more Texans may become uninsured if subsidies were to expire, according to KFF.
Debate over the subsidies is at the crux of the federal government shutdown, which began on Oct. 1. Democrats say they won’t vote to reopen the government unless the subsidies are extended. Republicans say they won’t consider extending the subsidies unless Democrats reopen the government.
Here’s what to know about the ACA health insurance and open enrollment.
What is ACA health insurance?
Health insurance purchased through the Affordable Care Act, which was signed into law March 2010, is often referred to as Obamacare. It is a marketplace where Americans and legal residents can purchase health coverage. While some states have their own marketplace to buy insurance, Texas does not and Texans interested in ACA coverage can purchase a plan in the federal marketplace through Healthcare.gov.
The law marked a significant step toward reducing the national uninsured rate, which was 17.8% in 2010. This rate has decreased to 8.2% in the first quarter of 2024.
SEE ALSO: How the government shutdown impacts El Paso SNAP beneficiaries
Many people choose ACA coverage because they don’t have employer-sponsored insurance, or make too much to qualify for Medicaid. In Texas, low-income young mothers, their children and the poorest disabled and elderly individuals are the most common enrollees in Medicaid.
According to Census data, the most common type of insurance is employment-based insurance, covering 47.4% of the state’s population in 2023.
Here are the types of insurance:
- Employer-sponsored insurance: Coverage offered as a benefit by employers, who usually chip in to help pay for the cost.
- Insurance purchased independently: Coverage purchased directly by an individual through the ACA marketplace or from a health insurance company.
- Government-subsidized insurance: Low-cost or no-cost coverage offered most commonly through Medicaid and the Children’s Health Insurance Program. These programs are largely funded by the federal and state governments. Medicare, which provides low-cost coverage to the over-65 population, is federally subsidized.
To qualify for Medicaid, you must be either an adult with low income, a child, pregnant, aged 65 or older, or have a disability. Your eligibility depends on at least one or a combination of these. You can check with your state’s Medicaid agency to apply, or create an account with the ACA marketplace. The latter will check if you or anyone in your household qualifies.
For CHIP enrollment, the beneficiary must be a child under the age of 18. A pregnant woman of any age can apply for perinatal services or Medicaid for her unborn child. Enrollees also must be a Texas resident or a U.S. citizen or legal permanent resident. You can apply here.
What are the different tiers of ACA health insurance and how much do they cost?
There are five tiers for plans: bronze, silver, gold, platinum, and catastrophic. The cost you pay varies by plan.
Bronze plans cover 60% of costs of services and you pay 40%. Silver plans cover 70% and you, 30%. Gold plans pays 80% and you, 20%, and finally platinum is 90% and 10% respectively. Gold and platinum plans have the lowest deductibles.
Reserved for people under 30 or those with low income, the catastrophic plan offers low monthly premiums but very high deductibles. It covers the same services other plans do, like emergency services, prescription drugs, maternity care and preventive care. They also cover at least three primary care visits per year.
The number of insurers, including familiar companies such as Cigna, UnitedHealthCare and Blue Cross Blue Shield, vary by county. Those plans can be found here.
Who is eligible to purchase ACA health insurance?
You must be a U.S. citizen or national or lawfully present in the U.S. Incarcerated people also can’t buy ACA coverage. There is no income limit.
How can I apply for ACA insurance?
There are many websites that look similar or claim to be the official website to sign up for ACA health insurance, but HealthCare.gov is the only one run by the federal government.
There are also options to enroll over the phone for free and through a physical application that is mailed in. Brokers and agents that work for health insurance companies that offer ACA plans can also help with signing you up for ACA coverage. Clinics and nonprofit organizations also have staff members, such as navigators, to help you sign up for ACA coverage and Medicaid or CHIP.
When is open enrollment this year?
Open enrollment, or the period to sign up for ACA health insurance for next year, opens Nov. 1 and closes Jan 15. 2026.
How much could premiums increase if tax subsidies expire?
The premium tax credits are claimed by 83% of Texans who get health insurance through the ACA.
These tax credits operate on a sliding scale based on income to offset the cost of premiums and are paid directly to insurers. As income goes down, the size of the tax credit goes up.
But those tax credits are set to expire at the end of the year, making any Texan who earns over $62,600 a year ineligible for the subsidy and ending the additional subsidies that have allowed Texans earning less than 150% of the federal poverty level — $23,475 for individuals — to pay little to no monthly premium.
Health policy organization KFF projects that Texans who use ACA tax credits will see premiums rise by an average of 115% or $456 per year.
What are some terms I should know when shopping for health insurance?
- Premium: The amount you pay for your health insurance per month.
- Deductible: The amount you pay before your insurance starts to pay. After this you also pay either a copayment, a fixed amount for the health care service, or coinsurance, where you pay a percentage of the covered cost.
- Out-of-pocket maximum: The maximum amount of money you have to pay in a year before your health plan pays 100% of the covered benefits.
- Out-of-network provider: A provider whose services are not covered by your health insurance plan and you may end up paying the full price of the service.
- In-network provider: A provider whose services are covered by your plan. Even if the service is considered in-network, there may be a co-pay that you must pay for the service. plan.
- Insurer: The company supplying the insurance.
- Policy: A policy is a package of covered health care items and services that your health care plan will pay for.
- Claim: A bill submitted by the provider to the health insurance company so that the provider can be paid for the services that are covered by the plan. If you’ve paid the full cost of the service up front, you can also submit a claim to the insurance company for reimbursement.
- Beneficiary: You or the person who is enrolled in the health insurance plan.
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