Using a local health insurance broker in the Crossroads can allow you to find the best coverage and rates for you and your family through the health insurance Marketplace. We assist you by shopping all of the plans in your specific zip code and complete the enrollment process for you free of charge! Don’t overpay for your health insurance or make costly mistakes. Our services are no cost to you, use a local Victoria agent today!
What Is the Affordable Care Act?
The Affordable Care Act (ACA or Obamacare) was created with the goal of making health care affordable and accessible to Americans, increase the quality of care, and reduce health care costs. Health insurance plans are offered through the Marketplace, which is a federal program established by the ACA, that facilitates the purchase of health insurance plans through private companies.
Guaranteed Issue
One of the provisions of the Affordable Care Act is that all plans on the Marketplace are guaranteed issue. This means that acceptance into a plan is guaranteed regardless of your age, gender, health status or pre-existing conditions, making health care more accessible. Insurance carriers cannot charge higher premiums for pre-existing conditions either.
Minimum Essential Coverage
Health insurance plans must offer 10 essential health benefits to their participants, also known as minimum essential coverage, in order to be compliant with the Affordable Care Act. These health benefits include coverage for inpatient and outpatient treatment, emergency services, maternity and newborn care, mental health, prescription coverage, rehabilitative services, laboratory services, preventative services, and pediatric services including vision & dental.
Subsidies and Tax Credits
Subsidies and tax credits help lower the costs of your premiums as well as your out of pocket expenses such as deductibles, copayments and coinsurance. Income based subsidies are available to individuals and families that fall within 100% to 400% of the Federal Poverty Limit. Government subsidies provide assistance in the form of an Advance Premium Tax Credit that assist in the cost of monthly premiums, as well Cost-Sharing Reductions, that assist in deductibles, copayments, and coinsurance for low income individuals that are enrolled into a Silver Plan.
How Marketplace Health Insurance Works
Marketplace Insurance, also known as Obamacare or Affordable Care Act, offers insurance to individuals (under 65 years old) and families through Advanced Premium Tax Credits (APTCs) and Cost Savings Reductions (CSRs). Insurance plans are offered by private companies and premiums will be paid directly to the carriers.
The amount of that you’ll receive in Advanced Premium Tax Credits and Cost Savings Reductions is based on a few factors including your household size, income, and the age of the individuals that will be covered by Marketplace Insurance. Below is a chart of the different income amounts, based on household size, in relation to the Federal Poverty Level. We use this chart to determine eligibility for tax credits based on your household size and income.
Who Is Eligible for ACA Insurance?
To be eligible for Marketplace Health Insurance you need to be a U.S. citizen, national, or non-citizen that is lawfully present. Those who are incarcerated are not eligible for Marketplace insurance. You must also file a tax return in order to receive your tax credits that can be used for your insurance premiums. Failure to file a tax return could result in you not receiving tax credits the following year.
If you are not offered health insurance benefits through your employer or are self employed you are eligible for Marketplace health insurance plans. If you are currently offered employee health insurance you must use the employer sponsored plan, unless it is deemed to be unaffordable by the ACA, which we can help you determine. Household members are also allowed to enroll into Marketplace plans if their coverage is deemed unaffordable based on your income (family glitch).
📊 2025 Federal Poverty Level (FPL) Chart for Premium Tax Credits
| Household Size | 100% FPL | 200% FPL | 300% FPL | 400% FPL |
|---|---|---|---|---|
| 1 | $15,060 | $30,120 | $45,180 | $60,240 |
| 2 | $20,440 | $40,880 | $61,320 | $81,760 |
| 3 | $25,820 | $51,640 | $77,460 | $103,280 |
| 4 | $31,200 | $62,400 | $93,600 | $124,800 |
| 5 | $36,580 | $73,160 | $109,740 | $146,320 |
| 6 | $41,960 | $83,920 | $125,880 | $167,840 |
| 7 | $47,340 | $94,680 | $141,020 | $189,360 |
| 8 | $52,720 | $105,440 | $158,160 | $210,880 |
| For each additional person, add | $5,380 | $10,760 | $16,140 | $21,520 |
Advanced Premium Tax Credits are a credit that is given to you in advance based on your household size and income to assist in the cost of health insurance premiums. If you’re application is done incorrectly it could result in you paying back some of your tax credits at the end of the year. We recommend using an agent, like myself, to assist you with this process to avoid costly mistakes and penalties.
Marketplace Plans are required to provide Minimum Essential Coverage under the Affordable Care Act. This ensures that you will have the basic health insurance coverage for the plan that you choose. Marketplace plans are also guaranteed issue, meaning they are required to accept you to a plan, regardless of any prior or current health conditions.
Health Insurance Plans Victoria, TX
The marketplace offers a wide variety of plans from different carriers based on your specific zip code or service area. Plans are broken up into 4 different categories: Bronze, Silver, Gold, Platinum. Each one of these categories will come with different tax credits and cost saving reductions. The level of care and quality does not differ based on category, the differences will be in your out-of-pocket expenses, cost of your premiums, and cost of your deductible.
Marketplace insurance will be offered in different plan types based on the zip code or service area you are located in. The most common plan type in the Crossroads area will be an HMO (Health Maintenance Organization). HMOs utilize a network of doctors, specialists and hospitals that service their members. It’s important to check the networks of the carriers and plans to make sure you will be able to see your primary doctor and any specialists you may see. Our team will do this for you when assisting with your enrollment!
When to Enroll In Marketplace Insurance Plans
There’s multiple enrollment periods based on certain life circumstances as well as a yearly Open Enrollment Period that starts November 1st and ends January 15th. During this time period you can renew, sign up, or change your Marketplace insurance plan. Enrolling by Dec 15th allows your plan to start January 1st, and enrolling by the 15th allows your plan to start on February 1st.
Many individuals will qualify for Special Enrollment Periods (SEPs) throughout the year depending on certain life changes that could affect their health insurance coverage. The most common is loss of coverage due to job loss or changes, moving to a different zip code or service area, or a change in marital status.
We recommend using an agent when enrolling to avoid application errors and penalties. We can assist you in the enrollment process for Individual and Family Plans as well as shopping to find the best coverage at an affordable price for you! The enrollment process can be completed in as little as 15 minutes, let’s get you covered today.
How to Apply for ACA Health Insurance Plans
You can apply for ACA health insurance a few different ways, although it is recommended to have a licensed health insurance agent assist you with the process, allowing you to avoid costly mistakes and penalties.
We start by assessing your health needs both current and future to determine a plan that will be the right fit for you. We like to consider your potential out of pocket costs for the year in order to save you the most money on your coverage as well as any costs for care. We also verify that your providers are in-network to ensure they will accept the plan of your choice.
Once we’ve found the right plan for you we can enroll you over the phone, online, or in person at our Victoria office. You’ll receive unbiased assistance from one of our agents to find the best plan based on your specific needs. We’ll also assist you in any documentation and determining the tax credits, subsidies, and cost sharing reductions you qualify for! Give us a call today at (361) 266-8995 to get Free enrollment assistance.
Why Choose Insurance With Don?
We strive to make the health insurance process as simple and hassle free as possible. We work with you to find health insurance that meets your needs and your budget. You’ll receive our expert help throughout the entire process as well as after you’re enrolled, we’re always a call or text away!
By working with a licensed health insurance broker in the Victoria area you can find the best rates in town, meet with us in person, and have personalized help from someone who knows the area. Give us a call today (361) 266-8995 or schedule your consultation to get started!