Last year in Fort Worth, Trey was juggling work and family when open enrollment for health insurance came around. He figured he had plenty of time to sort things out, but by the time he got around to it, the deadline had passed. He didn't know that there was a deadline for enrolling on the health insurance marketplace.
As a result, his coverage didn’t start on January 1st. A couple of days later, his daughter needed emergency surgery. Trey faced thousands of dollars in out of pocket costs that could have been avoided had he taken a few moments to secure a health insurance plan for the new year.
If you’ve been putting off selecting your health insurance for 2025, don’t let Trey’s experience become your story. There’s still time to act, but open enrollment deadlines and health coverage options make now the best time to secure your coverage. Here are three key things Texans need to know about ACA health policies before December 31st.
1. Open Enrollment Ends Soon
Open enrollment for ACA health policies runs from November 1st to December 15th. This is the time to sign up for a new plan or renew your existing healthcare coverage for the coming year. If you miss this window, your marketplace coverage cannot start until February 1, 2025. This condition for health insurance coverage is what put Trey into his financial burden last year. It is important to use the open enrollment period prior to December 15th.
Without health insurance coverage, even a minor medical event can lead to significant financial hardship. Like Trey learned last year, the cost of going uninsured can add up quickly. Waiting too long can also limit your choices, as some insurance companies will begin to remove some or all of their marketplace plans. Taking action now avoids a last-minute rush and ensures your policy will start on January 1st, protecting you from unexpected gaps in coverage.
You can still enroll all the way to the end of January with a later coverage effective date. After that you will need to qualify for a special enrollment period due to a life change like getting married or having a baby.
2. ACA Plans in Texas Are Limited to HMO or EPO Types
In Texas, ACA health plans fall into two categories: HMOs (Health Maintenance Organizations) and EPOs (Exclusive Provider Organizations). Understanding how these plans work is vital to picking the right one for you and your family.
- HMO Plans require you to select a primary care physician (PCP) who oversees your care. Referrals are needed to see specialists, and the plan only covers in-network providers, except in emergencies. This makes HMOs a good option for those comfortable staying within a defined network to save on costs.
- EPO Plans offer more flexibility because you don’t need referrals to see specialists. However, like HMOs, they only cover in-network care, so it’s essential to confirm that your preferred doctors and hospitals participate in the plan’s network.
Trey realized that choosing the wrong provider network could have meant losing access to his family’s trusted pediatrician. He now takes extra care to check that the providers his family relies on are in-network. Texans should do the same before selecting a plan to avoid surprises.
3. Federal Subsidies Can Lower Your Costs
One of the biggest advantages of ACA health plans is the availability of health insurance subsidies to help reduce costs for many Texans. This is done through a premium tax credit that can be applied either on your tax return or monthly premiums. These subsidies are based on annual income level and household size and can significantly lower your monthly premium.
For example:
- An individual earning less than $60,000 annually may qualify for reduced premiums.
- A family of four earning up to $120,000 could also benefit from subsidies, making comprehensive health coverage far more affordable.
Trey didn’t realize that updating his household income information during the open enrollment dates could adjust his eligibility for financial assistance. When he missed the deadline, he also missed out on savings he could have used for his family’s healthcare. Make sure your household details are accurate during enrollment to maximize your subsidy and get the most affordable plan for your situation.
Don’t Wait to Act—Take Control Now
Trey’s experience was a wake-up call that he is still paying for almost a year later. Missing deadlines and overlooking marketplace health plan details left his family vulnerable to financial stress that could have been avoided. With open enrollment ending soon, now is the time to review your health plan options and secure coverage for the year ahead.
If you’re feeling overwhelmed, Insurance For Texans can help. Our team specializes in simplifying the process, from explaining the differences between HMO and EPO plans to calculating the best subsidy options for you. We work with you to find the right ACA policy that fits your needs and budget. We also have options like short-term health insurance and catastrophic plans that are not on the marketplace platform. Our goal is to match your family to the health insurance coverage that is right for you.
Don’t let the deadline pass you by. Click the button below to connect with Insurance For Texans and find the ACA health plan that works for you. Take action today to protect your family and your finances in 2025.