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Ashley PoynterAug 15, 20196 min read

Health insurance 101: Texas silver plans for freelancers

Updated: Jun 24

It’s almost time for open enrollment, which means many in The Lone Star State are beginning to explore Texas silver plan options. If you are a real estate agent, freelancer, or other self employed individual, this article is for you!

We will look at everything you need to know going into open enrollment for 2020 health plans. Overall, it appears that rate increases for 2020 coverage will be less steep than previous years. Plans take effect on January 1, 2020; those seeking coverage prior to that date should look for a short-term plan. As with 2019, there will not be penalties for being uninsured in 2020 in most states. That said, it’s highly recommended that self employed individuals purchase coverage. Now is a good time to start researching the best plan for you and/or your family.

Overview of Texas health plans

Texas health plans fluctuated a bit in previous years, with some insurers leaving the exchange and others joining. In general, Texas has been very hands-off with regard to ACA. It is one of under five states that relegates the review of ACA-compliant plans to the Centers for Medicare & Medicaid Services (CMS). Enrollment for 2018 was down roughly 8% year-over-year because of a shorter enrollment period and cuts to federal funding. Here are some other tidbits you need to know if you’re looking for Texas silver plan coverage for 2020.

Open enrollment

Open enrollment for 2020 coverage will run per usual, from November 1, 2019 to December 15, 2019 in Texas. Those who already carry an individual market plan and switch to a new one during this open enrollment window will continue to be covered through December 31, 2019 (as long as premiums are paid on time), with the new plan coverage beginning on January 1, 2020.

For those self employed individuals who are shopping for insurance, it could take up to two months from the time of enrollment until a new plan kicks into effect. In these cases, it may be a good idea to use a short-term plan to cover that gap. These short-term plans may take effect as quickly as the next day after purchase.

For self employed individuals that want to enroll in a Texas silver plan prior to open enrollment, consider Decent’s Trailblazer silver plan. We offer open enrollment year round, so you don’t have to wait until November 1 to purchase new coverage or switch to a different Texas silver plan. Take a look at our Trailblazer plan details to see why you may be able to save money.

Premium subsidies for Texas silver plans

The Affordable Care Act offers government subsidies to help ease the financial burden of health insurance costs, including the premium tax credit. These premium subsidies are meant to match the cost each region’s benchmark plan so that when premiums increase, the premium subsidies do, too.

The premium tax credit can be applied to any “metal” level of coverage (i.e. bronze, silver, gold, platinum), though is not applicable for catastrophic coverage. In general, bronze plans usually have the lowest premiums and leave the insured responsible for a greater amount of out-of-pocket costs, while premium plans typically have the highest premiums and lower out-of-pocket costs.

To qualify for the premium tax credit health insurance subsidy, your income must fall between 100 and 400 percent of the federal poverty level (FPL)—or 139 percent on the low end in states with expanded Medicaid. Texas has not expanded Medicaid, so those looking to enroll in a Texas silver plan and qualify for a subsidy should consult these guidelines to verify eligibility.

Cost sharing reduction (CSR) for Texas silver plans

The ACA offers cost-sharing reductions (CSR) to keep overall health care costs (not just premiums) more affordable for people with modest incomes. Those with a modified adjusted gross income (MAGI) of between 100 and 250 percent of the FPL may be eligible for CSR benefits.

The U.S. Department of Health & Human Service (HHS) was reimbursing insurance carriers to cover the cost of CSR until October 2017. As a result, insurers started adding the cost of CSR to Texas silver plan rates. This also boosted premium subsidies, as they are based on the cost of silver plans. This added cost is known as “silver loading” and is expected to continue in 2020. That said, HHS is considering new federal rules that could possibly take effect in 2021, though this does not impact silver loading for the 2020 enrollment period.

In short, CSR amounts to a discount that decreases the amount people pay for health care (deductibles, coinsurance, out-of-pocket maximum, and copays). CSR is sometimes referred to as “extra savings” in the Health Insurance Marketplace. It’s important to note that those that qualify must enroll in a Silver plan to get the extra savings.

Can self-employed individuals get a Texas silver plan?

In 2018, it was estimated that 57 million U.S. workers were part of the gig economy. Technology has played a big role in this self employment trend. Some are in between jobs, while others enjoy the flexibility of working for themselves. No matter the reason, this trend is expected to continue, with some projecting that more than half of the country will be freelancing by 2027.

There are many benefits to being self employed—but there are downsides, too. One of the biggest (and most expensive) cons to is finding self employed health insurance. Many turn to the exchange to find affordable health coverage. The use of “metal” categories simplifies the health insurance cost breakdown.

Decent Texas silver plan for self-employed

Self employed individuals looking for a Texas silver plan may want to consider Decent’s Trailblazer plan. This plan is customized for freelancers to be affordable, comprehensive, and easy-to-understand. Some benefits of our Trailblazer plan include:

  • Off-exchange plan priced at 20% below-market
  • Deductibles that are more than 40% below a traditional exchange-based Texas silver plan
  • Lower out-of-pocket maximum
  • Free primary care—that’s $0 to see your doctor at anytime
  • Free 24/7 telemedicine access to your primary care doctor
  • Preferred brand drugs at less than half the cost of a traditional exchange-based Texas silver plan

You can view a full rundown of our exciting new Trailblazer plan here.