Who this is for: Individuals and families buying their own coverage, self-employed people, and small-business owners deciding between individual and group plans.
ACA Marketplace (HealthCare.gov) plans in Texas
Texans shop for ACA Marketplace health plans through HealthCare.gov. Dagan helps you compare the Marketplace plans available where you live and narrow them down by network, prescription coverage and total cost.
Depending on household income, you may qualify for savings on Marketplace premiums. HealthCare.gov decides who qualifies and how much the savings are, based on the information in your application. Dagan can walk you through that application.
CHA Lifeguard is not affiliated with HealthCare.gov or CMS, the federal agency that runs the Marketplace.
Open Enrollment and Special Enrollment
Open Enrollment is the yearly window when you can sign up for a Marketplace plan or switch plans for the coming year. HealthCare.gov sets the dates, and they can change from year to year. Check HealthCare.gov or ask Dagan for the current dates.
Special Enrollment lets you enroll outside that window if you have a qualifying life event, such as losing other health coverage, moving, getting married or having a baby. HealthCare.gov decides whether you qualify and how long you have to act.
Dagan helps during both windows, so a mid-year change doesn't mean figuring out the Marketplace alone.
PPO vs HMO: choosing a network
The plan type decides how freely you can choose doctors and what you pay when you go outside the network. In general:
| HMO | PPO | |
|---|---|---|
| Network | Usually covers care only from in-network doctors and hospitals, except emergencies | Covers in-network care and usually some out-of-network care |
| Specialists | Often requires a referral from a primary care doctor | Usually no referral needed |
| Out-of-network costs | Usually not covered, except emergencies | Usually covered at a higher cost to you |
| Typical trade-off | Fewer choices, often lower premiums | More flexibility, often higher premiums |
Rules vary by plan, so check each plan's documents. Dagan compares HMO and PPO options on total cost and network access. Often the right choice comes down to whether the doctors you already see are in the network.
Health insurance for the self-employed
If you work for yourself, there's no employer plan to fall back on. You choose and pay for your own coverage. Self-employed professionals are one of the groups Dagan works with on individual health insurance, including Marketplace plans. If your income depends on your ability to work, it can also make sense to look at disability insurance.
There is a dedicated guide for self-employed and 1099 workers.
Individual or group coverage?
If you own a small business, you may be weighing individual plans for yourself against a group plan that also covers your staff. For very small teams, the choice is often between individual coverage and a micro-group plan. Dagan can compare both and revisit the decision as your team grows. See how group health insurance works for small businesses.
Checking your doctors, prescriptions and pre-existing conditions
Under the Affordable Care Act, Marketplace plans can't refuse to cover you or charge you more because of a pre-existing condition. What still differs from plan to plan is which doctors and hospitals are in network and how your medications are covered.
Before you choose, Dagan matches your preferred doctors and your prescriptions to each plan's network and drug list (formulary). Networks and formularies can change, so confirm your providers and medications with the carrier before you enroll.
Help after you enroll
Dagan offers year-round support. That includes help with questions after you enroll, coverage changes during Special Enrollment, and following up on claims questions. You don't have to work out a carrier portal on your own.
Plan availability, benefits and costs vary by carrier, county and plan year.