Are There any Group Health Insurance Plans for Individuals in Texas?

Owning a small business involves many responsibilities. Do you have enough of what you need to keep your customers happy, are you making enough to sustain your business through the current period, and will you be able to keep up with the flow? Health is one aspect of the equation that is often overlooked as it is unpredictable. You cannot schedule a cold. You can’t draft a hospital stay. And you can’t certainly pay for premiums and medical expenses when you are away from the job whether you are a stay-at-home freelancer or a small business owner always on the go. We at CoverMile aim to answer the big questions about group health insurance plans and who qualifies for them and if you should apply for coverage.

Can I Get Group Health Insurance on My Own?

Let’s answer one question right away. If you own a small business, are you able to have group health insurance like the bigger companies? This answer is both a yes and no. It depends on how your small business is set up.

No. If your business is only you and you are the sole proprietor, then group health insurance won’t apply because to qualify for a group you need at least two employees. It is easier for you to shop the Marketplace and purchase an Affordable Care Act health insurance policy.

Yes. If your small business is a Limited Liability Company (LLC) then this changes things. You can obtain a group policy when you have two or more employees. You can be one of them. However, to obtain the policy there are sign-up stipulations. Health insurance companies ask for at least a 70 percent participation rate to sign up.

Ideally, you want to be insured on your own. Yet, if you have between two and fifty employees, you can assist them with obtaining insurance. Sometimes group insurance is your answer, other times it is not.

What are My Health Insurance Options as a Small Business Owner?

You want the best health insurance for your small business. Shopping around can become tedious and frustrating. We have searched and found that Blue Cross Blue Shield of Texas provides the best coverage at the lowest premiums for you, the business owner and your employees should you choose to include them under a small business health insurance plan.

Blue Cross Blue Shield of Texas

If you own a small business and want the best coverage for your employees, whether it be 2 or 50, then look no further than BCBS of Texas. To qualify for coverage, you must have 70 percent participation of your eligible employees. Eligible employees are those who work 30 hours per week, whom you withhold taxes, and who elect to receive coverage. Those who have coverage through a spouse or other means do not count toward your 70 percent. You also qualify as an eligible employee.

Below we have gathered a few of the plans available from BCBS of Texas under their small business platform. They have a variety of plans that include deductibles and coinsurance amounts.


SilverBlue Choice Platinum HMO – 202Blue Choice Gold PPO – 204Blue Advantage Silver HMO – 127Blue Advantage Silver HMO – 803
Out-of-Pocket Max$1500/$3000$8000/$16,000$9000/$18,000$9000/$18,000
Primary Care Visit$30 copay$30 copay$45 copay$45 copay
Specialist Visit$60 copay$50 copay$90 copay$90 copay
Emergency Room$300 deductible$300 deductible$600 deductible$500 deductible  
Urgent Care$75 copay$75 copay$100 copay$80 copay
Inpatient Hospital$200 deductible$150 deductible$350 deductible$380 deductible  
Outpatient Hospital$150 deductible$100 deductible$300 deductible,  $300 deductible  
Prescription (Pharmacy)$0/$10/$50//$100 $150/$250*$0/$10/$50//$100 $150/$250*$0/$10/$50//$100 $150/$250*$5/$15/30%/35% 45%/50%*

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

You also have the option to shop outside of group health insurance and purchase directly from the Marketplace. You can do this for a couple of reasons. One, you don’t qualify for group insurance or two, you just prefer to have individual health insurance. The good news is that you can still assist employees with their health insurance if you choose. More on this in a moment. Here are a few individual health insurance Texas plans from Blue Cross Blue Shield of Texas for small business owners.


SilverBlue Advantage Plus – 202Blue Advantage Plus HMO – 705Blue Advantage HMO – 205My Blue
Health – 405
Out-of-Pocket Max$9450/$18,900$9100/$18,200$9450/$18,900$9450/$18,900
Primary Care Visit$25 copay$40 copay$15 copay$0 for PCP – $30 all others
Specialist Visit50%$80 copay50% 40%
Emergency Room$950/occurrence deductible, then 50%40%$950/occurrence deductible, then 50%$950/occurrence deductible plus 40%  
Urgent Care$40 copay$60 copay$25 copay$0 first two, then $30
Inpatient Hospital$850/occurrence deductible, then 50%40%$850/occurrence deductible, then 50%$850/occurrence deductible plus 40%  
Outpatient Hospital$600/occurrence deductible, then 50%40%$600/occurrence deductible, then 50%$600/occurrence deductible, then 40%  
Prescription (Pharmacy)$5/$15/$30%/35%/ 45%/50%*$20/$40/$80/ $350/40%/40%$5/$15/30%/35% 45%/50%*$5/$15/30%/35% 45%/50%*

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

Is Group Health Insurance My Best Option for My Small Business?

If your small business is only you, or you and one individual, then it may be best for you to have individual insurance, especially if your employee has health insurance on their own or through a spouse. Group health insurance becomes your best option when your employee roster grows, and you are responsible for more than just a small circle of individuals. Until then, individual coverage through the Marketplace is your best option for insurance coverage.

This doesn’t mean you will leave your few employees uncovered. Remember, you have options. Here are a couple of options available to employers:

  • Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) – This is a reimbursement program small businesses use to assist employees with premiums, copays, coinsurance, and other medical expenses who have qualified medical coverage through another source. When an employee has a medical expense, they submit documentation of the event.

  • Health Reimbursement Arrangement (HRA) – Employers can also benefit from HRAs. If you do not have employees, you can purchase your health insurance policy through the Marketplace, set up your HRA, and receive reimbursement through your business.

Understand that when you take on a reimbursement program it must be equal to all employees, and you cannot discriminate. There are also limitations to how much each can contribute. It will also affect their premium tax credit status with Marketplace coverage. For 2024, the limits are $6,150 for self-only and $11,800 for a family.

Bottom Line

It is important to know you have options for individual health insurance Texas as a small business owner. The most important decision to make is to be insured. You never know when you will need to see a doctor or experience an emergency, especially as a small business owner. Take the time to talk with one of our experienced agents and we can guide you through the process of selecting the health insurance policy that best fits your situation and small business insurance needs. Contact CoverMile today.

Frequently Asked Questions

  1. Does Blue Cross Blue Shield of Texas offer group insurance for the self-employed?

    Yes. Blue Cross Blue Shield of Texas offers a variety of group health insurance plans. They offer health insurance to small businesses with two to fifty up to large businesses with over 150 employees.

  2. Can I provide health insurance for my employees if I don’t have group health insurance?

    You can assist your employees with health insurance they purchase through another source like their spouse’s employer or the ACA Marketplace. This is through a reimbursement program called QSEHRA (Qualified Small Employer Health Reimbursement Arrangement)

  3. Does group health insurance cover my family?

    It depends on how you set up the health insurance program. You are not obligated to cover your employee’s spouse and children under your group health insurance coverage. If you choose to, then it will work like a normal insurance policy, but you have to provide this benefit to all employees and not just a select few.

  4. Is individual health insurance better than group health insurance?

    From the employee’s point of view, they would have more options with individual coverage, especially if the employer is offering QSEHRA benefits. For you as an individual, it may be easier to purchase individual coverage on the Marketplace, especially if you have just a few employees. With group health insurance, employees have stipulations, and if you are close to the employee limit and fall below it, you may lose coverage the following year.

  5. Does Oscar health insurance offer group health insurance?

    Yes. They offer similar coverage; however, Oscar Insurance is limited to just a handful of counties. They are offered in San Antonio, Austin, Dallas, El Paso, and Houston.