US Health and Life Plan Guide for Texas 2023

All You Need to Know About US Health and Life Plans for 2023 in Texas

To save time when looking for health insurance, an insurance shopper usually selects one of the big three: Blue Cross Blue Shield, Aetna, or UnitedHealthcare. Why? You know the names,   you just want to get the job done. Who has time to do all the research? But did you know that you could be losing money? You have options, can save money, and have the same health coverage that the bigger names provide. This is because of the Affordable Care Act mandate. All providers must carry the same health coverage for all. We at Cover Mile are here to assist you with understanding what US Health and Life have to offer you and help you save money in the process.  

Also, in this guide, it is important to understand that Ascension is the parent company for US Health and Life. You will see both names used synonymously in our review. However, understand your health insurance plan will be through Ascension.

Health Insurance Terms to Understand

Before we begin, if you are not completely familiar with health insurance terms, let’s review some of them. You will see these frequently when you shop for insurance; they are common across all companies and plans. Knowing the basics can help you determine the best health insurance coverage for you and your family.

DeductibleA deductible is the amount you will pay out-of-pocket before your co-insurance begins to pay its portion. US Health and Life (Ascension) has deductibles between $0 and $9100, depending on the plan you select. Deductibles are based on the calendar year and refresh each year. They also determine your premium. The higher your deductible, the lower your premium will be; the lower your deductible, the higher your premium. Deductibles are broken down into two parts:

            Individual: This is the per-person deductible.

            Family: This is the deductible for the entire family

Your deductibles are listed on your Summary of Benefits, often in fraction form. For instance, $750 Individual/$1500Family; or abbreviated, $750/$1500. Each family member has their own $750 out-of-pocket expense to reach. This refreshes each year. You can read more about deductibles here.

Co-insurance – Co-insurance is a cost-sharing benefit between you and the insurance company. Once your deductible is met, this benefit kicks in. It is expressed in your Summary of Benefits as a percentage and will always reflect the portion you will pay. For instance, for a Silver metal level, you pay 40% of medical expenses after your deductible is met. This, too, refreshes each year.

Out-of-Pocket Max Insurance plans have an out-of-pocket max. This is a failsafe to help larger families, those who visit the doctor regularly, or those with chronic medical conditions. When you meet your deductible, pay through your co-insurance, and reach your out-of-pocket max, your policy pays 100 percent of medical expenses for that person on the policy for the remainder of the policy term.

Primary Care Physician – Your Primary Care Physician is the doctor you see for your general medical care. US Health and Life (Ascension) is an EPO, and you are required to remain within your network of providers. If you seek treatment outside your network, you will not have coverage and are responsible for paying for the medical care you received.  

Copay –Copays are fees medical providers charge when you have an office visit. It is important to understand that this fee is for the visit alone and not for the treatment you receive. It can be a flat dollar amount or a percentage and can vary by treatment, medical event, and plan. Some medical events, like a well check-up or other preventive services, can be included in your visit. See your medical plan for details.

US Health and Life and the Affordable Care Act

All US Health and Life insurance policies in Texas are part of the Affordable Care Act. You can purchase their Bronze, Silver, and Gold plans through the Marketplace as well as on their website. Below we have listed the plans Ascension offers. We are listing them by deductible, co-insurance, and out-of-pocket max.

To simplify our table, we have listed deductibles and out-of-pocket maximums as fractions. The first number is the single-person deductible, and the second number is for the family. Also, keep in mind that these numbers reflect in-network doctors and facilities. Ascension is an EPO. You will pay out of pocket if you see an out-of-network provider.

US Health and Life Bronze

US Health and Life Bronze has four plans. All are offered both on the Marketplace and through the Ascension website. Bronze plans offer basic coverage, have higher deductibles and out-of-pocket maximums, but offer low premiums. They are best for those in good health and only see the doctor when they need their annual check-up or occasionally get ill.

BronzeUS Health and Life Balanced Bronze 1US Health and Life Balanced Bronze 2US Health and Life No Deductible BronzeUS Health and Life Standard Bronze
Out-of-Pocket Max$9100/$18,200$9100/$18,200$9100/$18,200$9100/$18,200
Primary Care Visit$50 copay$25 copay$50 copay$50 copay
Virtual Primary Care$25$10$25$25
Specialist Visit$100 copay$0 copay$100 copay$100 copay
Virtual Specialist$50$20$50$50
Emergency Room50%$0$100050%
Urgent Care50% $0 copay50%$75
Virtual Urgent Care$64$30$64$64
Inpatient Hospital50%$0$2000 copay/day50%
Outpatient Hospital50%$0$1000 copay50%
Prescription (Pharmacy)$20/50%/50%/ 50%*$15/$0/$0/ $0*$30/$150/$250/ RX deductible*$25/$50/$100/ $500*

*Prescriptions are Generic, Preferred, Non-Preferred Brand, and Specialty – RX Deductible applies on some plans and levels.

US Health and Life Silver

US Health and Life also has four Silver plans. All are offered on and off the Affordable Care Act Marketplace. Plans sold at the silver metal level offer premium tax credits. You can also qualify for cost-sharing reductions (CSR) if you live between 100% and 250% of the Federal Poverty Level (FPL). These plans offer lower premiums and out-of-pocket maximums.

SilverUS Health and Life Balanced SilverUS Health and Life Low Premium SilverUS Health and Life No Deductible SilverUS Health and Life Standard Silver
Co-insurance0% after deductible50%40%40%
Out-of-Pocket Max$5400/$10,800$8900/$17,800$9100/$18,200$8900/$17.800
Primary Care Visit$0$40 copay$30 copay$40 copay
Virtual PCP$0$20$15$20
Specialist Visit$0$80 copay$60 copay$80 copay
Virtual Specialist$0$40$30$40
Emergency Room0%50%$100040%
Urgent Care$050%$100 copay$60 copay
Virtual Urgent $60$45$60
Inpatient Hospital0%50%$200040%
Outpatient Hospital0%50%$100040%
Prescription (Pharmacy)$0/$0/$0/ $0*$25/$50/50%/ 50%*$25/$100/50%/ 50%*$20/$40/$80/ $350*

*Prescriptions are Generic, Preferred, Non-Preferred Brand, and Specialty – RX Deductible applies on some plans and levels.

US Health and Life offers CSR plans through the Marketplace to those who qualify. Each plan level fits a different FPL bracket. You will notice these plans have lower copays and out-of-pocket maximums. This is a sample of the Cost-Sharing Reduction plans offered. To see a complete list, visit the Ascension website.

Silver – CSRStandard Silver 73Low Premium Silver 87Balanced Silver 94
FPL bracket201% – 250%151% – 200%100% -105
Co-insurance40%40%0% after deductible
Out-of-Pocket Max$7,200/14,400$2100/$4200$500/$1000
Primary Care Visit$30 copay$10 copay$0 copay
Specialist Visit$60 copay$20 copay$0 copay
Emergency Room40%40%0%
Urgent Care$45 copay40%$0 copay
Inpatient Hospital40%40%0%
Outpatient Hospital40%40%0%
Prescription (Pharmacy)$20/$40/$80/ $350$20/$40/50%/ 50%*$0/$0/$0/ $0*

*Prescriptions are Generic, Preferred, Non-Preferred Brand, and Specialty – RX Deductible applies on some plans and levels.

*NOTE: If you do not qualify for Affordable Care Act tax subsidies, contact Cover Mile today. We can help you find the cheapest health insurance in the state of Texas. Currently, Ascension has some of the best rates in the market.

US Health and Life Gold

US Health and Life has only one Gold plan. It is available through both the Marketplace and its website. Gold is the highest level of coverage. It provides the lowest deductibles, copays, and cost of insurance. With that, you will notice the price tag. Gold plans are best suited for those who visit the doctor regularly, have chronic medical conditions, or may require advanced medical treatment in the near future.

When shopping for US Health and Life Gold plans or any insurance plan in general, always read your Summary of Benefits carefully. Some policy benefits are not paid fully until you meet your deductible. If you need assistance selecting an insurance plan, contact Cover Mile. We would be glad to assist you in selecting an Ascension policy that best suits your family’s needs.

GoldUS Health and Life Standard Gold
Out-of-Pocket Max$8700/$17,400
Primary Care Visit$30 copay
Virtual Primary Care$15
Specialist Visit$60 copay
Virtual Specialist visit$30
Emergency Room25%
Urgent Care$45 copay
Virtual Urgent Care$60
Inpatient Hospital25%
Outpatient Hospital25%
Prescription (Pharmacy)$15/$30/$60/$250*

*Prescriptions are Generic, Preferred, Non-Preferred Brand, and Specialty – RX Deductible applies on some plans and levels.

Additional Coverages through US Health and Life

American Indian and Alaskan Native coverage levels

US Health has two additional plan levels, Limited Cost and Zero Cost; these are specialty plans for those who hold American Indian and Alaskan Native ancestry. Each of these plan levels is available on each plan on the Marketplace.

Finding a Doctor or Facility in Your Network

US Health and Life is an Exclusive Provider Organization (EPO). With this type of health insurance, you must remain within the network of providers they are contracted with. However, in a medical emergency, you are able to see a provider outside the network.

Ascension allows you to search for doctors and facilities near you on their website. You can also search for information about Specialty Care for conditions such as cancer, neurology, and cardiology.

US Health and Life Comparison Charts:

For a complete comprehensive list of US Health and Life Affordable Care Act plans, follow the links below.

Comparison ChartPlanPlan
US Health and Life Gold PlanEnglishSpanish
US Health and Life Silver PlanEnglishSpanish
US Health and Life Bronze PlanEnglishSpanish

Benefit Notices:

Keep in mind that the above is a summary of highlights only.

–The benefits above represent what a member would pay using in-network providers. When a non-participating provider is used, benefits are reduced.

–You are required to pay costs up to your deductible before the plan pays for covered services. What is shown is the per-person deductible and out-of-pocket maximum. Please see your plan for details.

 –All percentages shown are of the allowable amount for covered services.

 –Prescription drug payment level tiers: Generic, Preferred, Non-Preferred Brand, and Specialty

Prescription deductible applies on some plan levels above the Generic drug tier.

Prescription Coverage with Ascension

With all US Health and Life (Ascension) health plans, subscribers receive prescription coverage. You can search your prescription drug by plan. Then by name, class, and tier. Benefits plans have:

  • Mail Order Pharmacy – Ascension offers mail order through Express Scripts. Their website allows you to check your order status, request a refill, or pay your bill.
  • Drug Pricing ToolYou can use the Price a Medication tool to determine how much a medication will cost and if there is a less expensive alternative.
  • 90-day SupplyDepending on your drug benefit, you may be able to receive a 90-day supply of your prescription to save on your medication cost.

US Health and Life can help you find a pharmacy in your area through its website.

At Cover Mile, we desire to assist you in finding the health insurance in Texas that best suits you and your family. We will take the time to talk you through your options, help you understand each US Health and Life plan, and help you sign up for Affordable Care Act insurance. Contact us today.

Frequently Asked Questions

  1. Does Ascension Health have an insurance plan?

    Yes. The parent company is known as Ascension; US Health and Life is the health insurance company that provides plans for consumers. All policies carry both names. They follow Affordable Care Act guidelines by providing plans with the 10 Essential benefits. You can apply for insurance during the annual Open Enrollment period that begins on November 1 and lasts through December 31 each year.

  2. Does Ascension Health take Aspirus Health Plan health insurance?

    Ascension Health and Aspirus Health Plan are both health insurance companies. They provide the same services. So, let’s answer this question in a different manner. Do Ascension Health and Aspirus Health provide the same services? They differ in that Ascension offers EPO plans, and Aspirus offers HMO and PPO plans. With EPOs, you must remain within your network, or you do not have coverage. The same can be said of an HMO. However, you do have some flexibility. With a PPO, you can see any doctor or go to any facility you choose without seeking approval as long as it is in network. You can go out of network, but it will cost you more.

  3. Is Ascension a health insurance company?

    Yes. They were formed in 1999. In 2015, Ascension acquired US Health and Life and began to sell private health insurance to consumers using the blended name. They sell health insurance in five US states, Texas being the newest state acquired. Within Texas, they provide coverage to 19 counties.

  4. Does US Health and Life cover dental and vision?

    US Health and Life does not offer dental insurance for adults or children. However, they do cover vision insurance for children. Coverage copays depend on the metal level. They are limited to one exam and one pair of glasses per plan year. In the event of an emergency, under ACA guidelines the do offer dental services, but this would be do to an accidental injury.