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2023 Health Insurance Marketplace Updates and Changes to Know


If you are a Texan with no health insurance, you are not alone. Texas has the highest share of uninsured people in the country, with 16.6% of the population paying entirely out of pocket for healthcare.

Many Texans are tired of paying too much for medical services, whether uninsured or not. Luckily, changes to the 2023 health insurance marketplace will make it more affordable to get coverage.

However, other changes may make switching to a new insurance provider or plan the least expensive option. It all comes down to the type of plan you have, your eligibility for subsidies, and if you actively renew your policy.

Are you curious about the latest health insurance market changes that could affect your budget this year? If so, keep reading this guide for answers to the most-asked questions about health insurance updates for 2023.

Are Marketplace Premiums Going Up for 2023?

Yes, marketplace premiums are going up based on national averages. Texas is not spared from these rate hikes. In fact, Texas is home to some of the most significant rises in lowest-cost monthly premiums in the nation.

If you are worried about overpaying for insurance in Texas, Custom Health Plans can help you find the most affordable option.

Benchmark Silver Plan Premiums

Average silver plan premiums are expected to rise across the nation in 2023. Silver plans often serve as the benchmark for other tiers. If silver plan premiums go up, other metal tiers are bound to follow.

In Texas, that increase will look like an average of $454 monthly in 2023. Compare that to 2022, when the average silver plan premium was only $415 per month, and 2018’s average monthly silver premium of $419.

Insurance companies cite rising prices, inflation, and rebounding levels of medical service utilization as the main culprits for premium increases this year.

However, this year’s enhanced subsidies (more on this in a moment) will likely offset these price hikes. Unfortunately, the same is not true for people with unsubsidized health insurance premiums.

Unsubsidized Premiums

The bad news is that people with unsubsidized premiums will feel the hit of the price increases we mentioned above. The good news is that this is only a minority group since nearly 4 in 5 individuals have subsidized health plans.

This number has declined steadily since 2016, when the majority (56%) of individual market enrollees paid into unsubsidized health plans.

If you have an unsubsidized policy and are worried about rising premiums in Texas, Custom Health Plans is here for you. We can help you find ACA-compliant health coverage to optimize your savings.

Will There Be Marketplace Subsidies in 2023?

Yes, marketplace subsidies will continue into 2023 and through 2025. This is thanks to the recently passed Inflation Reduction Act (IRA), which aims to reduce costs for families and individuals of certain incomes.

Enhanced Marketplace Subsidies

The cost breaks available to low-income families and individuals in 2023 are even better than the original ACA subsidies.

Originally, policyholders within 150% of the federal poverty level (FPL) had to pay 4% of their household AGI toward health insurance. Note that 150% of the FPL equals about $20,000 for individuals and $42,000 for a family of four.

The IRA (and the American Rescue Plan Act (ARPA) before it) offers even more savings. Now, families and individuals within 150% of the FPL do not have to pay anything for health insurance.

Expanded Marketplace Subsidy Eligibility

The IRA has also continued the expanded eligibility requirements set in place by the ARPA in 2021. These acts have approved premium tax credit eligibility for enrollees making over 400% of the FPL.

400% of the Federal poverty line equals around $54,000 per individual or $111,000 for a family of four.

The updated eligibility guidelines restrict this group from paying more than 8.5% of their AGI to health insurance. The main goal of this update is to save older adults on age-adjusted insurance premiums.

The Family Glitch

The family glitch is a phenomenon that has caused increased health insurance costs for more than 5 million Americans. It blocked certain low-income families from claiming subsidies due to a household income calculation error.

In 2023, there are new rules to prevent the family glitch from happening.

What Are the New Marketplace Eligibility Rules for 2023?

Aside from the expanded marketplace subsidy eligibility rules, the health insurance marketplace will also have more insurance options available to more enrollees. These new eligibility rules include:

  • No longer allowing insurers to refuse marketplace coverage to policyholders who owed premium back-payments
  • Enabling people who miss Open Enrollment to sign up for coverage due to a qualifying life event
  • Not requiring documentation for people who experience certain qualifying life events and need to enroll outside of Open Enrollment
  • Allowing year-round enrollment for households within 150% of the FPL

These new rules should make it easier for people to obtain health insurance.

Is Automatic Re-Enrollment Still in Place in 2023?

Yes, automatic re-enrollment is still in place for healthcare plans in most states. However, experts recommend actively renewing your insurance plan this year to take advantage of additional insurance savings.

Failing to do so may lock you into new premiums and out-of-pocket costs you are unaware of. If you do not investigate your options, you may end up overpaying for health insurance.

Moreover, if the benchmark plan tied to your coverage changes, your marketplace subsidy may fluctuate, too. You may then have to pay the difference between the cost of your policy and the newly-enforced benchmark.

Even if you do not intend to actively renew your plan, ensure you update your application for 2024. Your subsidy is based on your expected income and household data for next year.

Failing to update this information on your application could prevent you from earning even more savings on health insurance. Or it could mean that if you qualify for less savings, you will owe the difference during tax season.

We Can Help You Navigate the Texas Health Insurance Marketplace

The health insurance marketplace is changing in 2023. Some people will save, and others will not. The only way to ensure you get the best price is to compare affordable health insurance plans near you.

Are you searching for ways to save on Texas health insurance? Custom Health Plans is here to help. Sign up for a free quote, and our expert brokers will find the best plan for you and your family.

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