What is the Best Family Health Insurance Plan in Texas?

Is Family Health Insurance Available in Texas?

A family can obtain health insurance through multiple sources. First, it is through a family member’s employer, and second, it is through the Marketplace. Both places have their benefits and can offer the best family health insurance plans in Texas. With an employer, you would be locked into the provider and plans they offer, and there may be a waiting period before benefits begin. Through the Marketplace, you are free to choose your insurance company. However, you must wait until November and the Affordable Care Act’s Open Enrollment to sign up. Timing is the real issue.

Most families purchase their health insurance through an employer. In fact, according to the Medical Expenditure Panel Survey – Insurance Component (MEPS-IC), sixty-three percent of Texas private sector employees worked for businesses that offer healthcare benefits. This study also revealed that over a ten-year period, insurance premiums have increased. For 2022, an employer-sponsored individual plan jumped to $7590 per year, and a family increased to $21,931 per year. It’s no wonder more companies are looking to push the responsibility to the employee.

If you or your spouse has recently lost employer-sponsored health care, then you can find health coverage through the Marketplace. You may qualify for a Special Enrollment Period and enroll now versus waiting until November and the Affordable Care Act’s Open Enrollment.

 

To assist you, we have researched the best family health insurance plans in Texas and are providing you with our top four choices below. Our review will explain why we’ve chosen them and what each company offers. It will also provide you with a plan coverage chart with four of their best plans.

Family Health Insurance Options

Every health insurance company is the same in that they offer health benefits that will meet your needs when you see a doctor or medical professional. We have the Affordable Care Act’s 10 Essential Benefits to thank for that. However, the ACA does not explain how each company provides that coverage.

In your research, you will find varying deductibles, coinsurances, and out-of-pocket maximums. From there, companies add features that attract the insurance shopper. Among these can be Virtual Care, Mail Order Pharmacy, and bells and whistles such as gym memberships and discount programs. Here, we list what each offers and how it will benefit you.

Blue Cross Blue Shield

The largest advantage Blue Cross Blue Shield of Texas has is that they are available statewide. They are the only health insurance company in our review that offers this benefit. By providing the most in-network coverage, when you need to see a doctor, you know you’ll have options for your family. This helps because, as an HMO, you are required to remain within your selected network or have reduced benefits or no coverage at all. The only exception would be in the event of an emergency where transportation to an in-network facility would be life-threatening. BCBS of Texas has two different networks, Blue Advantage HMO and MyBlue Health. The Advantage is their standard plan, and MyBlue Health is a low-cost option offered in select counties.

BCBS of Texas offers deductibles from $0 to $9450, depending on the plan you select. For 2024, they offer nine Bronze plans, eleven Silver plans, and nine Gold tier level plans. Subscribers have the benefit of Blue365, a discount program where members can shop and save on wellness products and services such as hearing tests, eye exams, and dental services. Blue Cross Blue Shield of Texas also offers their subscribers dental insurance as an add-on benefit.

Below, we are reviewing Blue Cross and Blue Shield of Texas Gold and Silver plans that offer the best benefits at the lowest premiums. These also offer the benefit of premium tax reductions. Silver plans include the addition of cost-sharing reductions.

	My Blue Health Gold – 403	My Blue Health Silver – 807	Blue Advantage Gold HMO – 706	Blue Advantage Silver HMO -705
Deducible	$1000/$2000	$0/$1,800	$1500/$3000	$0/$0
Coinsurance	30%	25%	50%	25%
Out-of-Pocket Max	$9450/$18,900	$9100/$18,200	$8700/$17,400	$1800/$3600
Primary Care Visit	$0 copay – select PCP/ $20 others	$0 copay	$30 copay	$0
Specialist Visit	30%	$10 copay	$60 copay	$10
Emergency Room	$950/visit plus 30%	25%	25%	25%
Urgent Care	$30 copay	$5 copay	$45 copay	$5
Inpatient Hospital	$950/visit plus 30%	25%	25%	25%
Outpatient Hospital	$850/visit plus 30%	25%	25%	25%
Prescription (Pharmacy)	$5/$15/$30%/ 35%/45%/50%*	$0/$15/$50/ $150**	$15/$30/$60/ $250**	$0/$15/$50/ $150**

*Prescriptions are Preferred and Non-Preferred Generic/Preferred and Non-Preferred Brand/Preferred and Non-Preferred Specialty

**Prescriptions are Generic, Preferred, Non-preferred, and Specialty.

Oscar

Next, let’s talk about Oscar Insurance. They are not as widespread as BCBS, only available in and around five cities: Houston, Austin, Dallas, San Antonio, and El Paso. In these counties, Oscar offers two different insurance networks, Choice and Select. Where you live will depend on which network you choose. There is no cost benefit to either one; the network itself is the difference.

One benefit that Oscar Insurance has is a Virtual Primary Care as well as a Virtual Specialist visit benefit, both of which draw a zero-dollar copay. The cost of a copay for a Virtual Specialist visit is unique to Oscar. They also have a low copay for generic prescription drugs, $0 to $3 per month, depending on the plan you select.

Oscar sells its plans within tiers in what they call suites: Simple, Classic, and Elite. We have samples of each below. Simple being the least expensive, Elite the most. Generally, Simple will have the highest coinsurance and deductible, and Elite will have the least and the lowest deductible. In addition, cost-sharing reductions are available on Silver plans for those who qualify.

They offer Affordable Care Act insurance on all three metal tiers. The main difference with Oscar is that they are an Exclusive Provider Organization (EPO). This differs from an HMO in that you are required to remain within the network of physicians you select, or you will not have coverage. The other difference is that they are more lenient with referrals. You do not need a referral to see a specialist as you would with an HMO. So, there are benefits and disadvantages of EPOs.

	Gold Classic Standard	Gold Elite	Silver Classic Standard -150	Silver Simple Specialist Saver
Deducible	$1500/$3000	$750/$1,500	$0/$0	$0/$0
Coinsurance	25%	30%	25%	25%
Out-of-Pocket Max	$8700/$17,400	$5500/$11,000	$1800/$3600	$1375/$2750
Primary Care Visit	$30 copay	$25 copay	$0	$5 copay
Virtual Primary Care	$0 copay	$0 copay	$0 copay	$0 copay
Specialist Visit	$60 copay	$50 copay	$10 copay	$5 copay
Virtual Urgent Care	$0 copay	$0 copay	$0 copay	$0 copay
Emergency Room	25% after deductible	30% after deductible	25% coinsurance	25% coinsurance
Urgent Care	$45 copay	$50 copay	$5 copay	$30 copay
Inpatient Hospital	25% after deductible	30% after deductible	25% coinsurance	25% coinsurance
Outpatient Hospital	25% after deductible	30% after deductible	25% coinsurance	25% coinsurance
Prescription (Pharmacy)	$15/$30/$60/$250*	$3/$75/30%/30%*	$0/$15/$50/$150*	$0/$20/50%/50%*

*Prescriptions are Generics: Preferred and Non-Preferred; Brand:/Preferred, Non-Preferred, and Specialty – percentages are subject to deducible

Ascension (US Health and Life)

Ascension offers three plans on its Bronze tier, three on its Silver tier, and one Gold tier plan. One benefit they offer that the others do not is a tier for American Indians and Alaskan Natives. This coverage level has its own benefit schedule. On the schedule of benefits, you will see it as Zero Cost and Limited Cost. Ascension offers health insurance in 19 Texas counties. Seven of them are available through the Marketplace. The other twelve are off-exchange plans you can purchase through their website.

Ascension is formerly known as US Health and Life. They have deductibles between $0 and $9450, depending on your plan selection. Like Oscar, they are an EPO, meaning you must remain within your network of physicians, or you will not have coverage. However, if you have an emergency, you are able to see a medical professional out-of-network. It is advised to contact Ascension as soon as possible to ensure coverage. They also offer virtual care options for both PCP and Specialists at a copay.

Most family health insurance companies offer savings programs to members; Ascension is no different. True Hearing is a discount program on hearing devices; Active and Fit offers health savings and gym membership discounts, and Ascension also extends savings to local sporting venues and attractions. As with all Silver tier insurance plans, those who qualify based on income can receive cost-sharing reductions.

	Ascension Personalized Care Standard Gold – EPO	Ascension Personalized Care Low Premium Silver – EPO	Ascension Personalized Standard Silver – EPO	Ascension Personalized Care No Deductible Silver – EPO
Deducible	$1500/$3000	$0/$0	$0/$0	$0/$0
Coinsurance	25%	50%	25%	40%
Out-of-Pocket Max	$8700/$17,400	$1200/$2400	$1800/$3600	$550/$1100
Primary Care Visit	$30 copay	$0 copay	$0 copay	$25 copay
Virtual PCP	$15	$20	$20	$15
Specialist Visit	$60 copay	$10 copay	$10 copay	$50 copay
Virtual Specialist	$30	$40	$40	$30
Emergency Room	25% after deductible	20% coinsurance	25% coinsurance	$550 copay
Urgent Care	$45 copay	50% coinsurance	$60 copay	$100 copay
Virtual Urgent	$60	$60	$60	$45
Inpatient Hospital	25% after deductible	20% coinsurance	25% coinsurance	40% coinsurance
Outpatient Hospital	25% after deductible	20% coinsurance	25% coinsurance	$550 copay
Prescription (Pharmacy)	$15/$30/$60/  $250*	$10/$20/50%/ 50%*	$0/$15/$50/ $150*	$25/$50/40%/ 40%*

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

Aetna

Finally, let’s discuss Aetna. The first thing you will want to know about Aetna is that they do not offer a Bronze tier in Texas for 2024. However, they do include Children’s Vision on all plans, and dental care is available when you purchase an off-exchange health plan. As for the other metal tiers, Aetna offers six Silver tier plans and four Gold tier plans. If you qualify for cost-sharing reductions, you have a host of additional plans available.

Aetna, like most of our other providers, offers a zero-dollar virtual visit benefit and a zero-dollar walk-in clinic in some locations. This can pair with their health allowance of $100, which they break down to $25 per quarter. You can spend these funds on CVS Health’s brand wellness products. In addition to these savings, you also receive a 20 percent discount on CVS Health brand products.

Aetna plans are EPOs. As a reminder, you must remain within your network of physicians and medical facilities or risk not having coverage. You can go out of network only in an emergency and with Aetna’s permission. Aetna is available in 41 counties across Texas around major cities like Austin, Corpus Christi, Houston, El Paso, and San Antonio. Aetna also offers an American Indian and Alaskan Native tier.

	Aetna Gold S: HMO	Aetna Texas Silver 5: HMO	Aetna Texas Silver S: HMO	Aetna Texas Silver 7: HMO
Deducible	$1500/$3000	$0/$0	$0/$0	$0/$0
Coinsurance	40%	50%	25%	50%
Out-of-Pocket Max	$/8700/$17,400	$1275/$2550	$1800/$3600	$895/$1790
Primary Care Visit	$30 copay	$50 copay	$0 copay	$5
Specialist Visit	$60 copay	$80 copay	$10 copay	$25
Emergency Room	25% coinsurance	50% coinsurance	25% coinsurance	50% coinsurance
Urgent Care	$45 copay	$100 copay	$5 copay	$5 copay
Inpatient Hospital	25% coinsurance	50% coinsurance	25% coinsurance	50% coinsurance
Outpatient Hospital	25% coinsurance	50% coinsurance	25% coinsurance	50% coinsurance
Prescription (Pharmacy)	$15/$30/$60/ $250*	$0/10%/40%/ 50%*	$5/$25/$55/ 40%/50%*	$5/$25/$55/ 45%/50%

*Prescriptions are Preferred Generic, Preferred Brand, Non-Preferred Generic/Brand, and Non-Preferred Generic/Specialty

Summary

We have reviewed four of the top family health insurance companies in Texas. There are others out there to consider. UnitedHealthcare is one of them, with their expanded network for 2024, they are gaining traction on Blue Cross Blue Shield as one of Texas top performers. The one benefit UHC has that others don’t is that if you are seeking Short Term Disability that is apart from an employer’s plan, you may want to consider taking a look at their health insurance offerings.

Shopping for Health insurance in Texas does not have to be complicated. It’s our job at CoverMile to do the hard work for you. We review the top companies and give consumers like you the information you seek to make an educated decision on the best family health insurance in Texas. Contact us today, and you can be on the road to a healthy 2024.