Health Insurance Marketplace / Health Exchange
How to Request Information and Assistance:
CommuniCare Health Centers has been designated by the Federal government as a Certified Agency to provide application assistance to those people seeking insurance coverage through the Health Exchange. CommuniCare Certified Application Counselors are able to assist your enrollment in the Exchange, Medicaid, CHIP, and Medicare plans, in English or Spanish, for the upcoming enrollment period of November 1, 2015 to January 31, 2016. Prior to November 1st, Counselors are available to answer questions and provide information about how to prepare for enrollment. You can contact CommuniCare's Insurance Enrollment Department at
(210) 233-7157 to speak with a Counselor. You can also get information about insurance coverage through the Health Exchange, Medicaid, CHIP, or Medicare either online or by telephone using the contact information listed below.
Health Insurance Marketplace / Health Exchange Informationhttps://www.HealthCare.gov/
Medicaid / CHIP Program Informationhttps://YourTexasBenefits.com/
Medicare / Advantage Plans Informationhttps://www.Medicare.gov/
Answers to Frequently Asked Questions:
Who Should Enroll?
Each state will have its own Marketplace for health insurance, also known as an Exchange, by Oct. 1, 2013. The Marketplace, which lets you shop for and buy insurance in person, online, or by phone, is mainly for:
- People who don't have insurance
- People who aren't insured by their employer
- People with pre-existing conditions who may have had trouble getting insurance before
- Small businesses
In Texas, the federal government will operate the health insurance Marketplace.
When You Can Enroll: From November 15, 2014 to February 15, 2015. Coverage will begin in 2014. If you want your coverage to start Jan. 1, 2014, you have to sign up by Dec. 15.
Texas's Plans, Benefits, and Costs
Companies can offer four types of plans: bronze, silver, gold, and platinum. These "metal level" plans all cover the same benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers. Here's how it works:
- Bronze Plan: You pay 40% and the plan pays 60%
- Silver Plan: You pay 30% and the plan pays 70%
- Gold Plan: You pay 20% and the plan pays 80%
- Platinum Plan: You pay 10% and the plan pays 90%
Catastrophic plans may be available, especially for people who are under 30 and healthy. These plans cost less up front, but they don't give you as much coverage. They generally require you to pay more out-of-pocket costs.
Companies may offer multiple plans within the same metal level. The plans and premiums would vary based on the deductible amount, co-payments, co-insurance, and other factors.
You must have at least a bronze-level plan to meet minimum requirements under the Affordable Care Act and avoid the penalty for not having health insurance.
Costs: Premium rates are not yet available for Texas.
Tobacco Surcharge: Texas allows insurance companies to charge tobacco users 50% more than non-tobacco users.
Who Is Selling Insurance in the Texas Marketplace: The companies that will offer coverage through the Marketplace have not yet been announced.
What's covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. In Texas, the benefits include:
1. Outpatient services, such as doctor visits or tests done outside a hospital
2. Emergency services
3. Hospital stays
4. Pregnancy and baby care
5. Mental health and substance abuse services, including behavioral health treatment
6. Prescription drugs, including generic and certain brand-name drugs
7. Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with developmental issues. In Texas, habilitative services, including physical, occupational, and speech therapy, are covered for children with autism up to age 10.
8. Lab tests
9. Preventive and wellness services, along with those that help people manage chronic conditions. This includes chiropractic care.
10. Services for children, including dental and eye care.
Some services not included: weight loss surgery, weight loss programs, long-term care, acupuncture, and cosmetic surgery.
Will These Benefits Be in All Plans? Although all health insurance policies have to include these benefits, some states may allow insurance companies to substitute a service that has the same value. For example, one type of lab test may be substituted for another. Make sure to read the summary of benefits of the plans you are considering to see if they include the coverage you need.