Affordable Care Act resource page

This page contains some basic resources for people and employers about the federal Patient Protection and Affordable Care Act (PPACA). More information is available from the federal government at

Federal resources | TDI resources | Federal provisions | Contact TDI

Federal resources

TDI resources

Federal provisions

Health insurance marketplace

Texas doesn't have a state-based health insurance marketplace. You can buy coverage through the federal marketplace during open enrollment each year from November 1 to December 15 each year. People with incomes between 100 and 400 percent of the federal poverty level may be eligible for premium and cost sharing subsidies.

Essential health benefits

  • The Affordable Care Act requires individual and small employer group plans to cover a minimum package of essential health benefits.
  • The essential health benefits package is based on the coverage offered in the most popular plan in Texas' small group market, the BCBS Blue Choice PPO. See Plan Summary | Full Plan Document | More Information
  • Preventive Care - Individual and small and large employer plans are required to provide certain preventive care services without cost sharing.

Premium rates

  • The law imposes restrictions on the range of rates that different policyholders may be charged for the same policy.
  • The law sets a minimum medical loss ratio (MLR), which requires health insurers and HMOs to spend 80 to 85 percent of premiums on health-related expenses or pay rebates to consumers. See more information on the MLR or look up information about your insurer.

Employer mandate

  • Employers with 50 or more full-time and full-time-equivalent employees may be required to pay tax assessments if their employees receive subsidized coverage through the marketplace because the employer doesn't offer minimum coverage or because the coverage offered is unaffordable. 
  • Employers with 25 or fewer employees may be eligible for tax credits if they provide health insurance.
  • Find general information for employers or find answers on employer responsibilities.

Grandfathered plans

  • Plans issued before March 23, 2010, are not subject to many of the requirements of the federal reforms and won't include many of the required coverages.
  • Find more information on grandfathered plans.

Contact TDI

For answers to general insurance questions, for information about filing an insurance-related complaint, or to report suspected insurance fraud, call the Consumer Help Line at 1-800-252-3439 or visit our website.

File an insurance complaint

For information on filing an insurance-related complaint, visit our website or call the Consumer Help Line.

Help us prevent insurance fraud

Report suspected insurance fraud to the TDI Fraud Unit online or by calling our Consumer Help Line.

For more information contact:

Last updated: 02/06/2019