Understanding ACA Coverage in Texas: Navigating the Income Thresholds

The Affordable Care Act (ACA) has played a significant role in expanding health insurance coverage for millions of Americans. However, the specific requirements for eligibility and subsidy qualification vary from state to state. This blog post aims to clarify the income thresholds for ACA coverage in Texas, a state that has not adopted Medicaid expansion.

The Medicaid and ACA Income Thresholds in Texas

In most states, individuals and families with incomes below 138% of the Federal Poverty Level (FPL) qualify for Medicaid. However, Texas is among the states that have not expanded Medicaid to cover all low-income adults. As a result, the income threshold for ACA subsidy qualification in Texas is lower than in other states.

For individuals and families in Texas, the minimum income required to qualify for ACA coverage is 100% of the FPL. This means that individuals with incomes above 100% of the FPL may be eligible for subsidies to reduce the cost of health insurance premiums.

Income Thresholds for ACA Coverage in Texas

Family Size 100% of FPL in 2023 138% of FPL in 2023
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1 $13,590 $18,755
2 $18,310 $25,149
3 $23,030 $31,543
4 $27,750 $37,937
5 $32,470 $44,331
6 $37,190 $50,725

Implications for Low-Income Texans

The low income threshold for ACA coverage in Texas creates a “coverage gap” for individuals and families who earn too much to qualify for Medicaid but not enough to qualify for ACA subsidies. This gap leaves a significant number of low-income Texans without access to affordable health insurance coverage.

For example, a family of four in Texas with an annual income of $25,000 would be eligible for Medicaid in most states. However, in Texas, this family would not qualify for Medicaid and would also not be eligible for ACA subsidies because their income is above 100% of the FPL. This family would face the full cost of health insurance premiums without any financial assistance.

Seeking Assistance and Resources

If you are a low-income Texan who is struggling to afford health insurance, there are several resources available to help you:

Contact a licensed health insurance agent: A licensed agent can help you explore your health insurance options and determine if you qualify for subsidies or other programs.
Visit HealthCare.gov: The HealthCare.gov website provides information on ACA plans, subsidies, and other resources.
Call the Marketplace Call Center: The Marketplace Call Center can answer questions about ACA plans and subsidies at 1-800-318-2596.

Understanding the income thresholds for ACA coverage in Texas is crucial for low-income individuals and families who need health insurance. By utilizing available resources, Texans can access affordable health insurance and protect their health and well-being.