Question 1

What is ObamaCare and is it the same as the ACA?

Accepted Answer

Yes. ObamaCare is the common nickname for the Affordable Care Act (ACA). It includes the Health Insurance Marketplace where Texas residents can enroll in subsidized individual and family health insurance plans.

Question 2

Do you offer Texas Medicare Supplement and Medicare Advantage plans?

Accepted Answer

Yes. TXInsurance.com is federally certified for Medicare Advantage and represents top-rated Medicare Supplement carriers across Texas.

Question 3

Do you write Texas small group health insurance?

Accepted Answer

Yes. We place Texas small group health insurance for 2–99 employees with BCBSTX, UnitedHealthcare, SANA and more — including husband-and-wife groups.

Question 4

What is ObamaCare / the ACA Marketplace in Texas?

Accepted Answer

ObamaCare is the nickname for the Affordable Care Act. In Texas, individuals and families enroll through HealthCare.gov (the federal Health Insurance Marketplace) and may qualify for a premium tax credit that lowers their monthly cost based on household income.

Question 5

Who qualifies for an ACA subsidy in Texas?

Accepted Answer

Most Texas households earning between 100% and 400% of the Federal Poverty Level qualify for a premium tax credit, and through 2025 the income cap is removed so higher earners can also qualify if their benchmark plan would cost more than 8.5% of income.

Question 6

When is Open Enrollment for ACA plans in Texas?

Accepted Answer

Open Enrollment for 2026 ACA coverage runs November 1, 2025 through January 15, 2026 in Texas. Outside that window you'll need a Special Enrollment Period — triggered by life events like losing job coverage, moving, marriage, or a new baby.

Question 7

Can I keep my doctor on an ACA plan?

Accepted Answer

Most likely — but networks vary by carrier and plan. Tell us your doctor and preferred hospital and we'll filter Texas ACA plans (BCBSTX, Ambetter, Oscar, UnitedHealthcare, Aetna CVS Health and more) that include them in-network.

Question 8

How is the ACA subsidy calculated?

Accepted Answer

The Marketplace caps what you pay for the second-lowest Silver plan (the 'benchmark') at a percentage of your household income, based on the Federal Poverty Level. Through 2025, that cap is 0% at the lowest incomes and 8.5% at the top — anything above that is paid as a premium tax credit.

Question 9

What income do I use for the ACA subsidy estimate?

Accepted Answer

Use your expected Modified Adjusted Gross Income (MAGI) for the coverage year — wages, self-employment income, interest, dividends, and most retirement distributions. The Marketplace reconciles the final subsidy on your tax return.

Question 10

Who counts as part of my household for ACA subsidies?

Accepted Answer

Your tax household: you, your spouse if filing jointly, and anyone you claim as a tax dependent. Roommates and partners you don't claim as dependents are separate households.

Question 11

Is this calculator the same as the official Marketplace estimate?

Accepted Answer

No — our tool gives a quick estimate based on Federal Poverty Level brackets. Your final eligibility and credit amount are determined by HealthCare.gov when you complete an application.

Question 12

When can I enroll in Medicare in Texas?

Accepted Answer

Your Initial Enrollment Period is the 7-month window around your 65th birthday — the 3 months before, the month of, and the 3 months after. Texas also follows the federal Annual Election Period (Oct 15 – Dec 7) for Medicare Advantage and Part D, and the Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31).

Question 13

What's the difference between Medicare Supplement and Medicare Advantage?

Accepted Answer

Medicare Supplement (Medigap) pays the gaps in Original Medicare and lets you see any doctor nationwide that accepts Medicare. Medicare Advantage (Part C) replaces Original Medicare with a private plan that usually has a network and often bundles drug, dental and vision coverage with a low or $0 premium.

Question 14

Do I need a Part D drug plan in Texas?

Accepted Answer

If you don't have creditable drug coverage from another source, yes — otherwise you'll owe a lifetime late-enrollment penalty. Most Medicare Advantage plans include Part D; if you choose a Medicare Supplement, you typically add a stand-alone Part D plan.

Question 15

Does TXInsurance.com charge a fee for Medicare help?

Accepted Answer

No. We're paid by the carriers, not by you. Your premium is the same whether you enroll directly with the carrier or through an independent Texas agent like TXInsurance.com.

Question 16

How many employees do I need for a Texas small group health plan?

Accepted Answer

Texas small group health insurance covers 2–99 employees. Husband-and-wife groups also qualify with most carriers. Larger employers (100+) move into the large group / level-funded market.

Question 17

Can I enroll a Texas small group year-round?

Accepted Answer

Yes. Unlike individual ACA coverage, Texas small group plans can be set up any month of the year. There is a separate guaranteed-issue window (November 15 – December 15) for groups that can't meet participation or contribution rules.

Question 18

What carriers do you offer for Texas small groups?

Accepted Answer

We place Texas small group health insurance with Blue Cross Blue Shield of Texas, UnitedHealthcare, SANA Benefits and other top-rated carriers — HMO, PPO and level-funded options.

Question 19

What is ICHRA and does it work in Texas?

Accepted Answer

An Individual Coverage HRA (ICHRA) lets a Texas employer reimburse employees tax-free for individual ACA plans they buy themselves. It's a flexible alternative to traditional group coverage and works for businesses of any size.

Question 20

Do dental insurance plans in Texas have a waiting period?

Accepted Answer

Most network dental plans cover preventive care (cleanings, exams, X-rays) on day one, but basic services like fillings often have a 3–6 month wait and major services like crowns can have a 6–12 month wait. Some plans waive waits if you had prior coverage.

Question 21

What is the annual maximum on a Texas dental plan?

Accepted Answer

Annual maximums commonly range from $1,000 to $5,000, with a few plans offering no annual cap. The higher the maximum, the better your protection against major dental work.

Question 22

Can I see any dentist with a dental plan?

Accepted Answer

Reimbursement plans let you visit any dentist and pay you back on a fee schedule. PPO and HMO network plans only pay full benefits with participating dentists, so check the network before you enroll.

Question 23

Can I enroll in dental insurance online without calling an agent?

Accepted Answer

Yes. Cigna dental plans can be self-enrolled online in a few minutes through TXInsurance.com's Cigna dental link, and Ameritas plans can be viewed and enrolled online directly as well. If you'd rather have a licensed agent shop multiple carriers and explain waiting periods first, call us.

Question 24

How much life insurance do I need?

Accepted Answer

A common rule of thumb is 10–15× your annual income, plus debt and any future obligations like a mortgage or college tuition. We'll walk through your specific Texas situation on a free call.

Question 25

Term life vs. whole life — which is right for me?

Accepted Answer

Term life is affordable coverage for a set period (10, 20 or 30 years) — ideal for income replacement while kids are young or a mortgage is outstanding. Whole life is permanent coverage that builds cash value and never expires, useful for legacy planning, final expenses, or estate liquidity.

Question 26

Do I need a medical exam for life insurance in Texas?

Accepted Answer

Not always. Many Texas carriers now offer accelerated underwriting or no-exam policies up to $1 million or more, with a decision in days rather than weeks. We'll match you to the simplest path that fits your health profile.

Question 27

What are living benefits on a life insurance policy?

Accepted Answer

Living benefit riders let you access part of your death benefit while you're still alive if you're diagnosed with a chronic, critical or terminal illness — turning life insurance into a financial safety net that pays even if you don't die.

Question 28

What is an accident plan and what does it cover?

Accepted Answer

An accident plan is a supplemental insurance policy that pays cash benefits when a covered accident or sickness occurs. It is built around two types of claims: accident (injuries, fractures, dislocations, burns, concussions, ER visits, urgent care, ambulance transport, hospital admission) and sickness (specified illnesses that trigger a benefit under the policy). Benefits are paid directly to you as cash to use for any expense.

Question 29

What are typical claim examples for an accident plan?

Accepted Answer

Common accident claims include broken bones, dislocations, burns, concussions, lacerations, ER and urgent care visits, ambulance rides, and hospital stays. Sickness claims depend on the specific policy and may include covered illnesses that trigger a set benefit. The plan pays a fixed cash amount based on the covered event, not based on the final medical bill.

Question 30

Who is eligible for an accident plan in Texas?

Accepted Answer

Accident plans are generally available to Texas individuals and families who want supplemental cash protection against unexpected injuries and covered sicknesses. Many plans do not require a medical exam, but eligibility, issue ages, and coverage limits vary by carrier. A licensed agent can confirm which plans you qualify for.

Question 31

How much does an accident plan cost?

Accepted Answer

Accident plans are designed to be budget-friendly. Individual premiums are often less than a few dollars per day, and family plans are available for households who want protection against the cost of an unexpected injury or covered sickness. Pricing depends on age, coverage level, benefit amounts, and whether you choose individual or family coverage.

Question 32

Does a small deductible apply to accident plans?

Accepted Answer

Yes. Many accident plans include a small per-cause or per-event deductible that you must pay before benefits are paid. The exact deductible amount, how it is applied, and whether it resets vary by carrier and plan. Read your policy details carefully or ask a licensed agent to explain how the deductible works on the specific plan you are considering.

Question 33

Is an accident plan ACA-compliant major medical coverage?

Accepted Answer

No. Accident plans are not ACA-compliant and are not a replacement for comprehensive major medical health insurance. They do not cover essential health benefits, pre-existing conditions, or preventive care the way an ACA plan does. They are supplemental coverage designed to work alongside your health plan to help with out-of-pocket costs after a covered accident or sickness.

Question 34

What should I watch for in the policy before enrolling?

Accepted Answer

Read the policy carefully for exclusions, limitations, waiting periods, and benefit definitions. Not every injury or illness is covered, and benefits are paid only for events that meet the policy's specific terms. Never cancel existing comprehensive health coverage until you are approved, active, and fully understand all materials presented.

Question 35

What forms do I need to enroll in ACA coverage in Texas?

Accepted Answer

You'll typically complete a HealthCare.gov application plus the carrier's enrollment form. We'll send you the right forms once we know whether you're going Marketplace, off-marketplace, small group, or Medicare.

Question 36

What is a broker-of-record (BOR) form?

Accepted Answer

A BOR designates TXInsurance.com as your agent of record on an existing policy at no cost to you. It lets us service your plan, handle claims questions, and shop renewals on your behalf.

Question 37

How do I submit a form to TXInsurance.com?

Accepted Answer

Email it back to us, upload it through your client portal, or bring it to your scheduled call. Most forms can also be e-signed — we'll send a secure link.

Question 38

Is TXInsurance.com a licensed Texas insurance agency?

Accepted Answer

Yes. TXInsurance.com is operated by a Texas Department of Insurance–licensed independent brokerage. Our license details and NPN are published on the Licensing page.

Question 39

Does TXInsurance.com charge a fee?

Accepted Answer

No. As licensed agents we're compensated by the carriers when you enroll. Your premium is the same whether you enroll directly or through TXInsurance.com — but you get an independent advocate.

Question 40

What carriers does TXInsurance.com represent?

Accepted Answer

We're appointed with Blue Cross Blue Shield of Texas, UnitedHealthcare, Aetna CVS Health, Cigna, Ambetter, Oscar, Humana, SANA Benefits and other top-rated carriers across health, Medicare, dental and life.

Question 41

Do you serve all of Texas?

Accepted Answer

Yes. We help clients statewide — Houston, Dallas–Fort Worth, Austin, San Antonio, El Paso and every county in between. We also serve clients in Florida, Oklahoma, Ohio, and select additional states.

Texas Insurance FAQ

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Group Health & ICHRA

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Forms & Enrollment

About TXInsurance.com

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