How Much is COBRA Insurance in Texas?

COBRA Health Insurance

When you leave a job that has provided health coverage, you have options. You can see if you qualify for an Affordable Care Act Special Enrollment Period and apply. You can also go without coverage until your new job’s probationary period has expired and apply for benefits, or you can accept the option of continuing your employer’s insurance plan through COBRA. But what does this mean? At CoverMile our job is to help you sort through the confusion. We intend to explain COBRA and see if it is the best option for you and your family.

What is COBRA Insurance?

COBRA is the Consolidated Omnibus Budget Reconciliation Act. Doesn’t sound much like insurance, does it? I can assure you it does have much to do with our topic. This reptilian topic name is about giving workers and families the right to choose to keep their health benefits when they leave their place of employment. This can be through quitting or a reduction of hours. However, if you were fired, then you may be out of luck. There are benefits and drawbacks to selecting COBRA. One, you can keep your health benefits. Two, you can see the same doctors. The downfall, you now assume the full cost of the insurance plan. This would mean the portion your employer paid.

How Does COBRA Insurance Work?

There are a few reasons one would receive the option for COBRA. These are:

If you are the spouse of the employee, you are given the same insurance rights. You can receive COBRA as well. In addition to the above reasons, you have these:

COBRA insurance is the same insurance plan you had when you were employed. The difference now is that you are paying the entire bill versus your employer paying a portion of it. You still have the same deductibles, copays, and out-of-pocket maximums. Also, when you assume paying on your own, you are picking up where you left off, it does not start over, this is one of the main benefits of selecting COBRA insurance.

How Much Will I Pay for COBRA Insurance?

As we have discussed, when you begin to pay for COBRA Insurance in Texas you are assuming your employer’s full insurance cost; your portion and the portion your employer was paying are now your responsibility, plus an additional two percent. This additional amount is an administrative fee that allows you to keep the coverage.

A 2023 KFF study reveals an average of how much this breaks down can be:

Annual Coverage	Single Coverage			Family Coverage
Plan Type	Employer	Employee	Total	Employer	Employee	Total
HMO	$6783	$1420	$8203	$16,600	$7158	$23,758
PPO	$7399	$1507	$8906	$18,120	$7108	$25,228
POS	$6940	$1456	$8396	$15,917	$6938	$22,854
HDHP	$6561	$1193	$7753	$17,041	$5,302	$22,344
ALL Plans	$7034	$1401	$8435	$17,393	$6575	$23,968

As you can see, an employer pays quite a large sum of an employee’s benefits. Most employees never realize how much of the bill an employer fronts for each employee just to enjoy the luxury of health insurance. This is one reason many skip the option of continuing their COBRA option. Paying $1979 per month for an HMO family coverage plan may be a bit out of budget, especially when you are out of your job.

COBRA and the Affordable Care Act

When you leave a job, you are given the option to continue your employer’s health coverage. Leaving a job triggers a Special Enrollment Period for the Affordable Care Act. If you find that COBRA health insurance is too expensive, you can search the Marketplace and shop for a health insurance plan from health providers such as Blue Cross Blue Shield of Texas and UnitedHealthcare.

Below we have listed Silver metal insurance plans from a few providers. You can find more through the link provided.

Blue Cross Blue Shield of Texas

BCBS of Texas is the largest insurance provider. They are available statewide. While they may not always be the most affordable or offer the best coverage, they are a good option for one seeking an alternative to COBRA insurance in Texas.

Silver	Blue Advantage Plus – 202	Blue Advantage Plus HMO – 705	Blue Advantage HMO – 205	My Blue Health – 405
Deducible	$1500/$3000	$5900/$11,800	$1950/$3900	$2250/$4500
Coinsurance	50%	40%	50%	40%
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 Visit	50%	$80 copay	50%	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%*
Children’s Dental/Vision**	No/Yes	No/Yes	No/Yes	No/Yes

**See plan details for limitations.

*RX: Generic, Brand preferred participating. Brand preferred non-participating, brand non-preferred participating, brand non-preferred non-participating, specialty.

UnitedHealthcare

UHC is another option for one seeking an alternative to the high cost of COBRA insurance. A few UHC includes are zero-dollar virtual visits, zero-dollar prescriptions for some medications, and dental screenings for children.

Silver	UHC Silver Virtual First	UHC Silver Standard	UHC Silver Value	UHC Silver Advantage+
Deducible	$3800/$7600	$5900/$9,100	$3250/$6500	$2500/$5000
Coinsurance	40%	40%	30%	30%
Out-of-Pocket Max	$9100/$18,200	$9100/$18,200	$9450/$18,900	$9450/$18,900
Primary Care Visit	$100 copay	$40	$0	$0
Specialist Visit	$100 copay	$80	50% coinsurance	$100 copay
Virtual Visits	$0	$0	$0	$0
Emergency Room	40%	40%	50%	$1000 copay
Urgent Care	$100 copay	$60	$75 copay	$100
Inpatient Hospital	40%	40%	50%	30%
Outpatient Hospital	40%	40%	50%	$750 copay per day
Prescription (Pharmacy)	$0/$3/$30/$100// 40%/50%*	$20/$40/$80 $350/ N/A	$0/$3/$30/$100/ 45%/50%*	$0/$3/$30/$85/ 40%/50%*
Children’s Dental/ Vision**	Yes/Yes	Yes/Yes	Yes/Yes	Yes/Yes

*RX: Preferred, Non-Preferred, Tiered 1-5

**See plan details for limitations.

Baylor, Scott and White

While many may not have heard the name Baylor, Scott and White, they are growing, now offering health insurance plans in 171 of Texas’ 254 counties. They also offer a zero-dollar telehealth benefit and a lower deductible than most Silver Metal plans. Some of their health plans will include zero-dollar Primary Care Physician visits for up to two visits.

Silver	BSW Prime Silver HMO – 003	BSW Prime Silver HMO – 008	BSW Prime Silver HMO – 005
Deducible	$5900/$11,800	$5900/$11,800	$1200/$2400
Coinsurance	40%	40%	0%
Out-of-Pocket Max	$9100/$18,200	$9450/$18,900	$9450/$18,900
Primary Care Visit	$40 Adult copay/ $0 Pediatric	$0 for first 2 visits/ $25 Adult copay/ $0 Pediatric	$0 for first visit/ $45 Adult copay/ $0 Pediatric
Specialist Visit	$80 copay	$35 copay	$85 copay
Emergency Room	40%	50%	$750
Urgent Care	$60 copay	$35 copay	$85 copay
Telehealth Visit	$0	$0	$0
Inpatient Hospital	40%	50%	$2000
Outpatient Hospital	40%	50%	$1000
Prescription (Pharmacy)	$20/$40/$80/ $350*	$15/$90/$140/ $500*	$20/$100/$140/ $500*
Children’s Dental/Vision**	No/Yes	No/Yes	No/Yes

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

**See plan details for limitations.

Should I Choose to Cancel COBRA Insurance in Texas?

Now the catch. If you do elect to sign up with a Marketplace health insurance plan instead of continuing your COBRA insurance in Texas, in most cases you will start over from scratch. This means that if you had previously met your deductible under your employer’s plan, it does not carry over to your new Blue Cross Blue Shield of Texas health insurance plan. This is one reason why many bite the bullet and pay the high monthly COBRA premium.

However, the Texas state constitution offers a conversion privilege. This allows those who are eligible to convert their group health plans to individual plans, even if they no longer qualify. This helps those with medical issues who don’t wish to start from scratch, you can maintain your current level of coverage deductibles, coinsurance, and out-of-pocket max you have already put into your current plan.

How Does COBRA Insurance Work with Medicare?

Having medical insurance such as Medicare, or nearing Medicare age, becomes a bit more tricky. Medicare has built-in timetables. Once eligible, you have eight months from the time you stop working, or no longer have a form of health coverage, to enroll in a Medicare Part B plan. Otherwise, you incur a penalty. This penalty will begin to add up the longer you go without a Part B portion, and you will pay this portion for as long as you have Part B. You cannot go back. So, while you consider COBRA insurance, if you leave a job and are given the option of COBRA insurance, that eight-month window, does not get reset if you choose the COBRA option because COBRA is not considered group health coverage. If you are of age, you need to choose your Medicare option or you will incur a penalty.

You can, however, choose to enroll in COBRA and Medicare simultaneously. Medicare will be your primary provider; COBRA will be your secondary insurance provider.

Summary

Sometimes COBRA is the right option for you and your family. At other times it is best to find another type of insurance, like through the Marketplace or apply for Medicare if you are of age. If you have questions, we are here to guide you. At CoverMile, we help individuals find the best health insurance to fit their situation. Contact us today.