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.

DeductibleA 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-insuranceCo-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 MaxInsurance 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 PhysicianYour 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.

CopayCopays 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.

BronzeAscension Personal Care BalancedAscension No Deductible BronzeAscension Standard Expanded Bronze
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$200050%
Urgent Care$0 after deductible50%$75
Virtual Urgent Care$30$75$75
Inpatient Hospital$0 after deductible50%50%
Outpatient Hospital$0 after deductible$2000 copay50%
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).

SilverAscension Personalized Care Low Premium Silver  Ascension Personalized Care No Deductible SilverAscension Personalized Standard Silver
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 Room50%$150040%
Urgent Care50%$100 copay$60 copay
Virtual Urgent$60$45$60
Inpatient Hospital50%40%40%
Outpatient Hospital50%$150040%
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 – CSRStandard Silver 73Low Premium Silver 87No Deductible 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$550/$1100
Primary Care Visit$40 copay$10 copay$25 copay
Specialist Visit$80 copay$20 copay$50 copay
Emergency Room40%40%$550 copay
Urgent Care$60 copay40%$100 copay
Inpatient Hospital40%40%40%
Outpatient Hospital40%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.

GoldAscension Personalized 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 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 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.

–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 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.

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.

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.