What to Do If You Can’t Afford Health Insurance from the Marketplace?

Having health insurance in Texas can mean the difference between receiving treatment now and waiting until a condition worsens and having no option but to visit an emergency room. It doesn’t have to be that way. You can see a doctor and receive treatment, get your prescription, and be on the road to recovery, even if you cannot afford health insurance from the Affordable Care Act Marketplace. There are multiple ways for you and your family to obtain health insurance and find the health care you need today.

Is Health Insurance in Texas Still Mandatory?

One of the advantages of having health insurance in Texas is that there is no longer a mandate to carry health insurance. This results from a 2019 reversal of the Affordable Care Act mandate that everyone carries health insurance. While a handful of states still require their residents to have insurance or face a tax penalty, Texas is not one of them. However, if you choose not to carry insurance, you risk not having the health coverage when you need it most. In addition, you won’t have the savings associated with a medical bill that would bring the cost of services to their negotiated rate. So, the real question is, while it’s true that carrying health insurance is your choice, can you afford the cost of insurance now or the cost of services when you visit the doctor later?

What are My Options in Texas if Affordable Care Act Insurance is Unaffordable?

When you feel that health insurance in Texas is out of reach for you and your family, you shouldn’t panic. There are always options. The first place to always look is the Marketplace website. It never hurts to apply and see what you may qualify for. There can be plans available and subsidies to low-income individuals that assist you in obtaining ACA plans. And this is where we will begin.

Subsidies through the Affordable Care Act: This is a premium tax credit that will go toward your insurance premium. It is generally for those between 100% and 400% of the federal poverty level. However, Texas did not pass the legislation and kept its levels between 100 and 133% of the federal poverty level. If you are above the threshold, you can still receive health care benefits. You would just not qualify for the tax credits.

Medicaid: When you and your family find yourself in a position where you cannot afford health insurance even with subsidies, you have options. One of these options is health insurance that is government-sponsored. You don’t have to qualify for this type of insurance and do not have to wait for an Open Enrollment period. You do need to qualify for it, however. Much like the ACA subsidies, you must meet certain qualifications: income, family size, and location.

Short-term Health Insurance: This type of insurance is not the best option as it is designed to bridge the gap between two types of insurance types. The main reason it is attractive is that it is relatively affordable. However, if you have any medical condition like high blood pressure or develop one while covered, your condition will most likely not be covered, or your application will be denied upon renewal.

Medicare: Depending on your age, you may be within the window to apply for Medicare. This window is from three months before your 65th birthday and three months following your birthday. If you have paid payroll taxes through an employer, you may qualify for free Part A Medicare; Part B will come with a premium. This can differ each year.

Insurance options are available to all at whatever income level you may find yourself. Just know there is a health insurance option in Austin, Dallas, or wherever you may live in Texas to receive the healthcare you and your family deserve.

How do I Sign Up for Health insurance in Texas?

The best way to sign up for health insurance in Texas is to apply through the Marketplace. Even if you are sure you will not qualify, you may be surprised at what you can find for you and your family. Even if you do not qualify for Obamacare insurance, the Marketplace is the best place to find out what you are eligible for.

Applying for Marketplace

First, gather together all your information:

Family Information: This includes everyone who lives in your home and who you will claim.

Income Information: Be sure to include the incomes of all who live in the home and who will be covered under your insurance policy.

Health Information: Not that this will exclude you from coverage, ACA insurance cannot deny you based on your health condition. But if you are currently covered now, you will need to know the current provider information. You will also need to specify if you have the ability to receive coverage through another source, like an employer.

After you apply and submit your application, you will be shown the plans available. You will also be informed if you qualify for tax credits like the above-mentioned Premium Tax Credits. This information will be automatic, and you do not have to request these credits to be applied to your Affordable Care Act application.

Applying for Medicaid

The great thing about the process of applying for Medicaid is that, in most cases, you don’t have to go out of your way to do so. While you can go directly to the Medicaid office, you can apply through the Marketplace, as we mentioned above. If any of your Marketplace application information suggests that Medicaid would be a good fit for you and your family, the Marketplace automatically sends it to your state agency for them to contact you. Of course, the Marketplace will still offer you options best suited to you and your family. As part of the ACA guidelines, it must do so.

Applying for Medicare

This is a bit different as Medicare is not part of the Marketplace, and you cannot obtain it through the above steps. As mentioned, you can receive Medicare if you have met the pay stipulations and attain the age of 65. In most cases, you will automatically begin to receive your Part A benefits. Part B is received if elected. If you don’t automatically receive it, you will need to sign up for Medicare within that seven-month window surrounding your 65th birthday. For 2023 the Part B premium is $164.90. If you do not sign up during your initial period, there is a penalty, and you lose part of your benefit depending on how long you go without signing up.

Applying for Short-Term Insurance

As stated, this is not always the best option for those seeking comprehensive health insurance. True, they are among the more affordable, but short-term health insurance was designed to be just that, short-term. It is to assist those with a gap in their insurance to have temporary insurance until they can obtain it from the next permanent source. For instance, a worker is waiting out a new hire probationary period.

Short-term insurance providers do not have to adhere to ACA guidelines and can exclude or deny coverage based on health conditions. While they offer up to thirty-six-month policies, they are usually not guaranteed renewable. And to make matters worse, losing a short-term health insurance policy would not trigger an open enrollment window for the Marketplace. So, if you were to lose your short-term policy in March, you would have to wait until the Affordable Care Act Open Enrollment period starts November 1st. You would be uninsured until January of the following year. Yet, it can be a decent alternative to traditional health insurance if you are young and healthy.

As you can see, many options exist for those who cannot afford Marketplace insurance. Some options have finances in mind, while others are designed as temporary options. Each person’s situation will ultimately weigh which option suits them.


Affordability is one of the greatest factors when shopping for health insurance for your Texas family. We at Cover Mile understand the struggle and aim to assist you in finding the health insurance plan that fits your needs and situation without breaking the bank. Contact us today.