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By |Published On: August 5, 2015|Categories: Health Insurance|

The source and funding of health insurance is still a political hot-button topic. Many people who have never had health insurance in Texas now have coverage, which was the main focus of the PPACA, or Patient Protection and Affordable Care Act, otherwise known as “Obamacare.” Other Texans lost coverage or were required to buy worse coverage for more money.

Getting health insurance in Texas can be difficult, if you don’t have someone to guide you through the different requirements. That’s why instead of buying through the government marketplace and insurance carriers, buying through Hettler Insurance Agency can get you the customer service needed.


It is estimated that 24% of Texas residents are still uninsured for health insurance. Surprisingly, 16% of these people have steady jobs that don’t provide insurance. Hundreds of thousands of Texans work steadily, yet do not have health insurance because it is not provided by employers. Private health insurance policies have, historically, been quite expensive, putting them out of reach for most people. The health insurance exchanges were developed in order to provide affordable policies for these individuals, as well as for those who are not currently employed.

Federal Health Exchange

The Affordable Healthcare Act detailed that each state could offer an insurance exchange in which insurance carriers would offer policies that fit into the criteria outlined by the law. If the state chose not to set up its own exchange the federal government would do so.

Governor Rick Perry, along with many other state governors, opted out of establishing a state exchange. The federal government, therefore established an insurance exchange for the citizens of Texas at healthcare.gov. These insurance carriers offer the various policies outlined by the ACA, with the goal to provide affordable policies with more standardized coverage. Hettler Insurance can help you find a policy through the federal exchange and through private marketplaces.

Open Enrollment in 2015 & 2016

Open enrollment ended this year on February 15th. For those still uninsured, it is possible to qualify for a special enrollment period. You will not qualify for the Minimum Essential Coverage, but your agent can help you to find a policy that will get you around the problems associated with more expensive policies.

If you did not get a policy before the open enrollment period ended, and you don’t qualify for special enrollment or exemptions, you’ll have to pay a fee for each month you do not have coverage. This is known as individual shared responsibility coverage and in July of 2015, it was reported the IRS mailed outstanding balances to individuals without health insurance coverage for 2014.

To find out if you are required to pay the fee, read below for common exemptions. To avoid the tax in the future, be aware of the next open enrollment period. Enrollment in the 2016 health exchange starts in November of 2015.


Your CPA or accountant can help you file for exemptions from the fine for going without health insurance. If you were uninsured for less than 3 months in 2014, you can file for an exemption. Also, if you don’t file federal income taxes, because your income is too low, you can get an exemption from the fine. If the cost of your policy would be 8% or more of your annual income, you can also be exempt from the fine.

In addition, Texas did not opt to expand Medicare coverage. This gives a break from the fines for anyone who makes 138% or less of the Federal Poverty Level. Your agent can tell you even more exemptions that are available.

Much like liability insurance for your car, health insurance is now mandatory, although the penalties aren’t as steep. You won’t lose your license or be out potentially thousands of dollars, but it will cost you and your family’s health and fees. If you missed the open enrollment period, find out which exemptions you qualify for and get an affordable plan. Your agent may be able to get you a Catastrophic Plan that has low premiums.

Changes in Status

You may need to change your health insurance policy if your status has changed. For example, if you have gotten married this year, your status has changed, and you may need to change your insurance accordingly. This is also true if you have a baby. Other changes in status include whether or not you or a family member qualifies for CHIP or Medicaid.

If you move, especially to another state, you need to check your insurance to make sure it transfers. You also need to take action if you have lost coverage through an existing policy, such as a job loss. There is a 60 day deadline to get enrolled in new coverage after losing an existing policy and 3 months before the PPACA fines are applicable.

Health Insurance for Disabled Texans

About 14% of Texans have some kind of disability. These disabilities can be either physical or mental. You may be classified as disabled if you have trouble walking, breathing, seeing, hearing, or working. Disabled citizens can qualify for Medicaid in many cases, but navigating the Medicaid network can be overwhelming for family members of disabled individuals. You can also apply for disability benefits from Social Security. Hettler Insurance can help point you in the right direction with the application process.

Pre-Existing Conditions

If you don’t qualify for Medicaid, you can still get health insurance. The PPACA makes it illegal for insurance companies to exclude customers because of pre-existing conditions. You also cannot be charged more for ongoing health problems. The only factors that can affect the cost of your health insurance are whether or not you use any kind of tobacco product, your age, where you live, and whether or not you are buying insurance for more than one person.

Cancellation of Health Insurance

Your Texas health insurance policy cannot be cancelled for anything other than failure to make payments or ending of employment with an employer providing insurance. If your carrier tries to cancel, or fails to renew your insurance policy, ask why. Hettler Insurance will keep you informed of any upcoming changes. You will also have an advocate who knows how to get another policy, should yours lapse. You should receive a written explanation of why the policy has been cancelled.

Remember, you must have health insurance. If you fail to pay for it, and it is cancelled, you will still have to find another policy.