US Health and Life Plan Guide for Texas 2024

All You Need to Know About Ascension Plans for 2024

If you live in and around the Austin area and are in search of the best health insurance in Texas, then this is one of the insurance companies you need to consider. Ascension covers Travis County and the eighteen surrounding counties with affordable healthcare. Shoppers usually, in their rush, pick one of the bigger three: Blue Cross Blue Shield, Aetna, or UnitedHealthcare. But did you know you could be losing money by not taking the time to research your options like Ascension? You have options, can save money, and have the same health coverage. We at CoverMile are here to assist you with determining if Ascension is the best health insurance in Texas for you.

Health Insurance Terms to Understand

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

Deductible – A deductible is the amount you will pay out-of-pocket before your insurance begins to pay its portion. Ascension, formerly US Health and Life, has deductibles between $0 and $9,450, depending on your plan selection. Deductibles are based on the calendar year and refresh each year. They also determine your premium. The higher your deductible, the lower your premium; the lower your deductible, the higher your premium will be. Deductibles are broken down into two portions:

            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, on a Silver metal tier, 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 maximum amount you will pay. 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, Ascension 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 (PCP) is the doctor you see for your general medical care. Ascension is an Exclusive Provider Organization (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.Visit the link to learn more about EPOs.

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 like immunizations, can be included in your visit. See your medical plan for details.

Ascension and the Affordable Care Act

All Ascension 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’ve listed them by deductible, co-insurance, and out-of-pocket max.

Keep in mind that all plans qualify for premium tax credits for those who are eligible based on income.

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.

Ascension Bronze

Ascension offers three plans on its Bronze tier. All can be found through the Marketplace. Bronze plans offer basic coverage but have higher deductibles and out-of-pocket maximums, yet they have low premiums. They are best for individuals in good health who only see the doctor for annual check-ups or when they occasionally get ill.

Bronze	Ascension Personal Care Balanced	Ascension No Deductible Bronze	Ascension Standard Expanded Bronze
Deducible	$9450/$18,900	$0/$0	$7500/$15,000
Co-insurance	0%	50%	50%
Out-of-Pocket Max	$9450/$18,900	$9450/$18,900	$9400/$18,800
Primary Care Visit	$25 copay	$50 copay	$50 copay
Virtual Primary Care	$10	$25	$25
Specialist Visit	$0 after deductible	$100 copay	$100 copay
Virtual Specialist	$20	$50	$50
Emergency Room	$0 after deductible	$2000	50%
Urgent Care	$0 after deductible	50%	$75
Virtual Urgent Care	$30	$75	$75
Inpatient Hospital	$0 after deductible	50%	50%
Outpatient Hospital	$0 after deductible	$2000 copay	50%
Prescription (Pharmacy)	$15/$0/$0/ $0*	$30/$150/ RX deductible+50%*	$25/$50/$100/ $500*

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

Ascension Silver

Ascension has three Silver metal tier plans. All are offered on and off the Affordable Care Act Marketplace. Plans sold at the Silver metal level offer cost sharing reductions. You qualify for cost-sharing reductions (CSR) if you live between 100% and 250% of the Federal Poverty Level (FPL).

Silver	Ascension Personalized Care Low Premium Silver	Ascension Personalized Care No Deductible Silver	Ascension Personalized Standard Silver
Deducible	$4000/$8000	$0/$0	$5900/11,800
Co-insurance	50%	40%	40%
Out-of-Pocket Max	$9000/$18,000	$9450/$18,900	$9100/$18,200
Primary Care Visit	$20 copay	$15 copay	$20 copay
Virtual PCP	$20	$15	$20
Specialist Visit	$80 copay	$60 copay	$80 copay
Virtual Specialist	$40	$30	$40
Emergency Room	50%	$1500	40%
Urgent Care	50%	$100 copay	$60 copay
Virtual Urgent	$60	$45	$60
Inpatient Hospital	50%	40%	40%
Outpatient Hospital	50%	$1500	40%
Prescription (Pharmacy)	$25/$50/50%/ 50%*	$30/$100/50%/ 50%*	$20/$40/$80/ $350*

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

Ascension 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 – CSR	Standard Silver 73	Low Premium Silver 87	No Deductible Silver 94
FPL bracket	201% – 250%	151% – 200%	100% -105
Deducible	$5700/$11,400	$1000/$2000	$0/$0
Co-insurance	40%	40%	0% after deductible
Out-of-Pocket Max	$7,200/14,400	$2100/$4200	$550/$1100
Primary Care Visit	$40 copay	$10 copay	$25 copay
Specialist Visit	$80 copay	$20 copay	$50 copay
Emergency Room	40%	40%	$550 copay
Urgent Care	$60 copay	40%	$100 copay
Inpatient Hospital	40%	40%	40%
Outpatient Hospital	40%	40%	$550
Prescription (Pharmacy)	$20/$40/$80/ $350	$20/$40/50%/ 50%*	$25/$50/40%/ 40%*

*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 CoverMile 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.

Ascension Gold

Ascension has only one Gold metal plan. 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 an Ascension Gold plan or any insurance plan in general, always read your Summary of Benefits carefully. Some policy benefits are not paid until you meet your deductible. If you need assistance selecting an insurance plan, contact CoverMile. We would be glad to assist you in selecting a policy that best suits your family’s needs.

Gold	Ascension Personalized Standard Gold
Deducible	$1500/$3000
Co-insurance	25%
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 Room	25%
Urgent Care	$45 copay
Virtual Urgent Care	$60
Inpatient Hospital	25%
Outpatient Hospital	25%
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 Ascension

American Indian and Alaskan Native coverage levels

Ascension extends additional plan offerings to American Indians and Alaskan Natives; these are specialty plans for those who hold ancestry status. Visit the link to see what Ascension offers.

Finding a Doctor or Facility in Your Network

Ascension 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.

Ascension Comparison Charts:

For a complete comprehensive list of Ascension’s Affordable Care Act plans, follow the links below.

Comparison Chart	Plan	Plan
US Health and Life Gold Plan	English	Spanish
US Health and Life Silver Plan	English	Spanish
US Health and Life Bronze Plan	English	Spanish

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.

–True Hearing discount program savings of 30-60 percent off of hearing devices.

–Active and Fit savings program. Health savings and gym membership discounts.

–Membership discounts to local sporting venues and attractions.

Prescription Coverage with Ascension

With all Ascension health plans, subscribers receive prescription coverage. You can search your prescription drug by plan. Then, by name, class, and tier. Benefit plans have:

• Mail Order Pharmacy – Ascension offers mail order through the Ascension RX Home Delivery pharmacy or contact Maxor Plus for other RX options.
• Drug Pricing Tool – You 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 Supply – Depending on your drug benefit, you may be able to receive a 90-day supply of your prescription to save on your medication cost.

Ascension can help you find a pharmacy in your area through its website.At CoverMile, we desire to assist you in finding the health insurance in Texas that best suits you and your family. We take the time to talk you through your options, help you understand each Ascension plan, and guide you through signing up for Affordable Care Act insurance. Contact us today.