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Obamacare 101: How The Texas Health Insurance Marketplace Will Work

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When it opens October 1st, this marketplace will not have any lines. At least that’s what we’re hoping. In Texas, the federally run health insurance marketplace (formerly known as “the exchange”), is an online shopping site designed to take the confusion out of buying private health insurance. So how will it work and who needs to shop there? We got the breakdown from Stacey Pogue of the Austin-based nonprofit, the Center for Public Policy Priorities.

Who can buy health insurance on the marketplace?

For a little over half of Texans, health insurance will remain a job benefit. The marketplace is really for people who buy insurance on their own, or who currently do not have health insurance currently. In Texas, there are about 6 million people without insurance (there are more than 700,000 uninsured residents in Dallas County, according to the 2010 census, or 31 percent of the population).

How can I access the marketplace?

  1. Online: At the site healthcare.gov
  2. By Phone: You can call 1-800-318-2596 24/7 to talk about the health plans with an operator in several languages.
  3. By Mail: You can fill out a 13-page application and send it by regular mail.

What plans will be available? 

Plans will be available at four levels of coverage: bronze, silver, gold and platinum. There will also be an option for some people under 30 to purchase catastrophic plans. While insurers don’t have to offer plans in all four levels, all insurers must offer at least one silver and one gold plan.

Every plan will cover a minimum set of essential benefits, such as emergency services, preventative and wellness services, prescription drugs and maternity care (see here for more).

How much will health insurance cost me?

No one knows for sure yet exactly how much the plans available on the marketplace will cost. That’s because in Texas, lawmakers voted to let the federal government run the marketplace, and the feds are still finalizing rates with insurance companies. The rates may not be available before the marketplace opens in September.

Who in Texas will qualify for a subsidy?

In Texas, an estimated 2.6 million people will be eligible for government tax credits to offset the cost of healthcare. Generally, these are people who don’t have the option of getting health insurance through their employers and who make less than $48,000 a year.

More From KERA News: Are You Eligible For Health Care Subsidies? Find Out Fast

How long will I have to sign up?

The Marketplace opens October 1st, and closes March 31st.

Lauren Silverman was the Health, Science & Technology reporter/blogger at KERA News. She was also the primary backup host for KERA’s Think and the statewide newsmagazine  Texas Standard. In 2016, Lauren was recognized as Texas Health Journalist of the Year by the Texas Medical Association. She was part of the Peabody Award-winning team that covered Ebola for NPR in 2014. She also hosted "Surviving Ebola," a special that won Best Long Documentary honors from the Public Radio News Directors Inc. (PRNDI). And she's won a number of regional awards, including an honorable mention for Edward R. Murrow award (for her project “The Broken Hip”), as well as the Texas Veterans Commission’s Excellence in Media Awards in the radio category.