On-Exchange:

Health insurance plans that are offered through the Marketplace – the Marketplace is similar a large online retail shopping store but for health insurance. Texas does not have their own state-run store; Texans purchase plans through Healthcare.gov. All Marketplace plans are required to provide essential health benefits and follow guidelines as set by the Affordable Care Act (ACA).

With On-Exchange plans, you may be eligible to receive a government subsidy depending on your household size and income, meaning that your monthly health insurance costs could be lower.

Off-Exchange:

Health insurance plans that are offered privately by each health insurance company. These plans also offer most if not all the essential health benefits as their on-exchange counterparts and are usually a mirror of their on-exchange plans. The names of the plans are often exactly the same as well.

The difference? You can’t buy these plans from Healthcare.gov. You also won't receive a government subsidy or discounts for these plans.

Effective January 1, 2023

• Bronze S
• Silver 1
• Silver 2
• Silver 3
• Silver 4
• Silver S
• Gold
• Gold S

*All Houston area Aetna CVS Health plans are accepted at Kelsey-Seybold Clinic*

You may need one or more of the following documents. (Additional documentation as required.)

• 1040 federal or state tax return
• Wages and tax statement (W-2 and/ or 1099, including 1099-MISC, 1099-G, 1099-R, SSA-1099, 1099-DIV, 1099-S, 1099-INT)
• Pay Stub
• Self-employment ledger documentation (can be a Schedule C, the most recent quarterly or year-to-date profit and loss statement, or a self-employment ledger)
• Social Security Administration Statements (Social Security Benefits Letter)
• Unemployment Benefits Letter

With Help from a Licensed Agent – Call 713-442-7033 and connect with a licensed insurance professional. There’s absolutely no charge for speaking with this professional and learning more about individual health insurance plans.

Through an agent you currently have a relationship with – If you are already working with an agent or broker. Tell them you are interested in joining a plan accepted at Kelsey-Seybold Clinic. Kelsey-Seybold Clinic is in-network in all Houston area Aetna CVS Health plans.

During Annual Enrollment, you can compare plans and pricing to see which plan is best for your situation. After you’ve completed an enrollment application, you will receive a confirmation letter from the health plan you selected.

1. Register your account online with Aetna CVS Health
2. Select a Kelsey-Seybold Primary Care Provider
3. Receive your ID card in the mail
4. Begin using services! Remember preventive services are covered 100%, so you won’t have any out-of-pocket expenses. In addition, preventive services generally do not apply to the deductible if your plan has one. 

Most people receive their approval within 7-10 days (or earlier) of completing an application.

In the case of an emergency, you would go to the nearest hospital. Emergency services are covered regardless of the location. For pre-scheduled procedures, the hospital network for the Aetna CVS Health Individual Marketplace plans includes CHI St. Luke’s and HCA.