Moon Insurance Managers, Inc.
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Tel. (281) 484-8320

Moon Insurance Managers, Inc. · TDI license #5595

Individual and Family Health Insurance

This page is for people buying their own health coverage in Texas — no plan through an employer, and not yet on Medicare.

We do not sell it — and this page is still worth your time, because the thing that goes wrong here is not price. It is not knowing what you have been offered.

Call (281) 484-8320 or jump to what the Marketplace hides
45 CFR Marketplace and benefits

What the regulation fixes

Essential health benefits
Ten categories, § 156.110(a)
Open enrollment
§ 155.410
Agent and broker duties
§ 155.220(j)
Adult dental and vision
In no EHB category
Ch. 2709 coverage
Not insurance, by statute
Agent of record
The Code of Federal Regulations and the Texas Insurance Code — general information only.

Before anything else

Start on HealthCare.gov

Texas uses the federal Marketplace. The plans, the metal levels and the premium tax credits all run through HealthCare.gov in this state; there is no separate Texas exchange, and the Marketplace is the only place a premium tax credit can be used.

For a straightforward situation it is enough on its own. One household, income that clearly qualifies for a subsidy, no employer coverage, no complications — the site works, the plans are comparable, and there is a free call centre. You do not need an agency to enroll and you will not get a better price through one.

What follows is the part HealthCare.gov cannot do.

Five categories, one vocabulary

What HealthCare.gov does not show you

HealthCare.gov shows Marketplace plans. It does not show the Texas market. Several things you will be offered — by mail, by phone, by a search result, by somebody at church — are invisible to that comparison, and some of them are not insurance at all.

What is out there, and what it is

The first of those is peculiar to this state. The Texas Legislature created a framework, now in the Insurance Code, for health benefit coverage a qualifying nonprofit agricultural organization offers its members — and the statute states that this coverage is not insurance and is not subject to the Texas Department of Insurance’s regulatory authority. That is not our opinion of it; it is what the law says it is.

The point is not that any of these is a scam. It is that they occupy five different regulatory categories, get described in nearly identical language, and the first question about any of them is “what is this, legally?” — not “what does it cost?”

Source: Tex. Ins. Code ch. 2709 (HB 3924, 87th Reg. Sess.). Verified .

Ten categories

What “essential health benefits” actually includes

An ACA-compliant plan has to cover ten categories of benefit — hospitalization, emergency and ambulatory care, maternity and newborn care, mental health and substance use treatment, prescription drugs, rehabilitative services, laboratory work, preventive and chronic disease care, and pediatric services, including oral and vision care.

Read that last one carefully. Pediatric dental and pediatric vision care are essential health benefits. Adult dental and adult vision are not. And even the pediatric benefit is not automatic: a Marketplace plan may leave pediatric dental out where a stand-alone dental plan is offered on that Exchange.

Our individual dental insurance page sets out that boundary in full, and individual vision insurance covers the eye half.

Source: 45 CFR §§ 156.110(a), 155.1065 — essential health benefits. Verified .

Two ways in, and only two

When you can enroll

The annual open enrollment period, once a year. It opens on November 1.

A special enrollment period, if a qualifying life event happens — losing other coverage, getting married, having or adopting a child, moving. Each has its own window and its own documentation, and missing the window generally means waiting for open enrollment.

About the closing date, and please read this rather than skimming it. The rule that sets when open enrollment ends for the 2027 plan year is currently the subject of litigation and an appeal. One version of the rule ends the window in December; the version that ran for recent years ended it in mid-January. As of the date on this page, the outcome is not settled.

So: confirm the deadline on HealthCare.gov before you rely on it. And if you want the answer that is safe under every version of the rule in play — enroll by December 15. That secures coverage starting January 1 either way, and it takes the argument out of your hands.

Source, and the litigation posture re-checked: 45 CFR § 155.410 — annual open enrollment period. Verified .

The honest answer

If your income is below the floor for help

Texas has not expanded Medicaid. Eligibility for premium tax credits generally begins at 100% of the federal poverty level for your household size.

So some Texans earn too much for Texas Medicaid — whose adult income limits are very low, and which for most adults requires more than low income to qualify at all — and too little for a premium tax credit. HealthCare.gov will tell you accurately that you do not qualify. It will not tell you what to do next.

We will not pretend to solve this. Federally qualified health centres and county programs exist and charge on a sliding scale, and Texas runs free benefits counselling on 2-1-1. What we will not do is sell you an excepted-benefit product and let you find out what it was at a hospital — which, since none of this is ours to sell, is an easy promise for us to keep.

Checkable duties

What a registered agent owes you

If you use an agent for Marketplace enrollment, federal rules require of them correct information without omission of material fact, documented consent before assisting, and documented confirmation that you reviewed the eligibility information — because assisted enrollment has been abused, with people enrolled or switched without knowing. We are telling you this about somebody else’s agent: if yours does not ask for consent and walk the application back through with you, something is wrong.

Source: 45 CFR § 155.220(j) — agent and broker standards. Verified .

Plainly

We do not sell this, and here is where to go

Moon Insurance does not place individual and family health insurance. We are not registered with the federal Marketplace, so we cannot enroll you in a Marketplace plan or help you claim a premium tax credit — and we do not write off-Marketplace individual health plans either.

We publish it anyway because knowing which of those five things is insurance does not require us to sell you anything. Where to actually go:

  • HealthCare.gov and its free call centre — for any Marketplace plan, and the only place a premium tax credit can be used.
  • 2-1-1 — free Texas benefits counselling, including for the gap below the premium-tax-credit floor.
  • Call (281) 484-8320 if you have been offered something and want to know what it legally is before you sign it. That question we will answer, and there is nothing behind it for us.

Moon Insurance Managers, Inc. · 360 FM 1959, Houston, TX 77034 · (281) 484-8320 · Texas Department of Insurance license #5595

Questions people ask

Do I need an agent to use HealthCare.gov?

No, and we could not help you there anyway — we are not Marketplace-registered. For a straightforward situation HealthCare.gov is genuinely adequate and has a free call centre.

Is a Farm Bureau health plan insurance?

Under Texas law, health benefit coverage offered by a qualifying nonprofit agricultural organization to its members is not insurance and is not subject to the Texas Department of Insurance’s regulatory authority. That is the statute’s own description, and it is worth understanding before you enroll rather than after.

What if I earn too little to qualify for help?

Texas has not expanded Medicaid, and premium tax credit eligibility generally starts at 100% of the federal poverty level. Call 2-1-1 for free benefits counselling. None of this is a line we handle, so there is nothing we could sell you instead even if we wanted to.

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