While health insurance in Texas is no longer mandatory, it is necessary when you become ill or have an injury and need to see a doctor or visit a hospital. You may be swamped with ads for Affordable Care Act insurance or see bulletins for your works benefits, but you are unsure what to do for your family. Through our discussion, we hope to inform you of what options are available to you and assist you in making an educated decision that will guide you to the health insurance plan that will best suit you and your family.
What Are My Health Insurance Options?
As we began, we already mentioned two of the options. However, there are several depending on your situation. Let’s review each of these so you have a better idea of what is out there, and then you can narrow it down and get your family the insurance coverage you seek.
Through your job – the first place to look is through your employer. A benefits package can often be an affordable option because your insurance is paid through your paycheck. Your employer will often pay a portion of the premium to help offset the cost of your insurance plan.
Affordable Care Act – When an employer does not offer health benefits, your obvious option is the Marketplace. When you apply, you are given options for health coverage based on the information you provide. This will lead to our next type of insurance.
Medicaid – If you are low-income, you may be able to qualify for Medicaid. You qualify by: being pregnant, responsible for a child under 18, having certain disabilities, or being 65 or older. Income is based on family size. When you apply for ACA insurance, you are automatically informed if you or someone on your application qualifies for Medicaid insurance.
Medicare – You begin qualification for Medicare three months before your 65th birthday, the month of, and three months after. If you have worked for ten years and paid Social Security taxes, your Part A will be free. Part B and Part D, prescription coverage, come at a premium.
Short-Term Health Insurance – This type of coverage is, just as it sounds, temporary insurance. It is designed to get you through a short period when you do not have insurance. For instance, you lose an employer’s coverage in May, and Open Enrollment for ACA insurance is not until November. A Short-Term Health plan will provide you coverage until January when your new health insurance plan kicks in.
Be aware that you can only enroll in a Marketplace health plan through the Open Enrollment period, which runs from November 1st through December 31st of each year or a January 1st start date. You also can late enroll until January 15th for a February 1st start date. There are special situations where you can qualify for a Special Enrolment period. Click here for more information.
Are All Insurance Companies the Same?
One would think that health insurance is health insurance because you can apply through the Marketplace. However, when you choose to purchase your plan off the ACA Marketplace and directly from an insurance company, it will not always be the same price and provide you with the same coverage options. Let us explain.
The Affordable Care Act has mandated that insurance companies provide these 10 Essential Health benefits. These include:
- Outpatient healthcare
- Emergency services
- Pregnancy, maternity, and newborn care
- Mental health and substance abuse disorder services
- Prescription drugs
- Rehab and habilitative services
- Laboratory services
- Preventative and wellness services
- Pediatric, including oral and vision care
However, beyond these mandated coverages, insurance companies can differ. This can include the benefits they cover, co-insurance amount, and copays. While on some level, they remain the same, be wary that they do differ and that your monthly premium can vary from one company to another.
What I Should Look for In an Insurance Company in Texas
It is okay to insurance shop. While you have the Essential Health Benefits, many providers offer extra benefits. For instance, some insurance companies provide Telehealth services. These are video visits in lieu of an in-office visit. Many offer this service at a zero-dollar copay.
When you shop, consider the following:
Network Type: This is a big one. Especially when you are shopping off the Marketplace. There are three basic types of insurance networks. HMOs, PPOs, and EPOs. Each has its differences, primarily with which doctors and hospitals you can go to and when. Let’s explore each.
Exclusive Provider Organization (EPO): EPO networks are the strictest. They only allow you to see the doctors and receive treatment at the facilities within the network. You do have a bit of freedom in that you do not need a referral to see a specialist. But if you try to see a doctor out of the network, you will pay out of pocket for services.
Health Maintenance Organization (HMO): With an HMO, you still have to remain within your network, but under certain circumstances, one can go outside the network to receive treatment with approval from the insurance company and in the event of an emergency. Also, with an HMO, you generally need to live within a geographical area of the network.
Preferred Provider Network (PPO): The most lenient of the networks. While you still have a network, you pay less if you remain within your insurance plan’s contracted network of doctors and facilities.
Insurance network types offered may vary by insurance company. Which one is best for you will depend on factors such as your family situation and covered member’s health condition.
Copay: We discussed this earlier. A copay is the amount you pay when you visit the doctor or facility to be seen. This is not for treatment; that is a separate expense. This amount can vary between health insurance companies in Texas as well. You may find one company with a zero-dollar copay for a primary care physician (PCP) visit, then another company with the same insurance coverage; their visit can be between $30-$60, depending on the plan you choose with them.
Co-insurance: This is the amount you will pay versus the amount the insurance company will pay after your deductible is met. You usually see it as a percentage. For example, 80/20 and 70/30 are common for insurance companies. The insurance company will pay the larger of the amount. Of course, the more they pay, the higher your premium. Within the Marketplace, at the levels of Gold, Silver, and Bronze, Gold will have the highest co-insurance and Bronze the lowest. Read your plan document carefully because prices are directly tied to the co-insurance. You may find a better-priced plan that will save you money with another company.
Deductible: Here is another factor that will determine your premium. A deductible is the amount you will pay out of pocket before your co-insurance kicks in. This can vary widely. Even within an insurance company itself, deductibles can carry different levels to assist shoppers afford their health insurance plans in Texas. The higher your deductible is, the lower your monthly premium will be. Deductible amounts can be around $5000 (or greater) on the higher end and $500 on the low end.
NOTE: On the higher-end deductibles, some insurance companies offer High Deductible Health Plans (HDHP). These allow special savings accounts to pair with them that assist with paying toward the deductible when you visit the doctor, have tests done, visit the emergency room, and other health-related expenses.
Also, look for other types of coverage, such as dental insurance and vision coverage. Often these are ancillary products that you add to health insurance, but some companies make it simpler to include with their insurance policies.
How Much is Health Insurance in Texas?
You would think we would have discussed cost by now, but you can’t always shop by price tag. This is why we left this category for the end. Now that we understand all that goes into health insurance, whether you live in Austin or El Paso, you can better select a health insurance company to purchase coverage for you and your family. As we have mentioned, costs will vary between companies, and having a fair comparison based on your situation is beneficial.
Before you begin, ensure your search has all the information you need. These are the most common questions that health insurance engines use to determine the best health insurance for you.
- How old are you?
- Where do you live?
- Who will be on your policy?
- Are you or anyone on your policy currently taking any prescriptions?
- Do you smoke?
The answer to these questions is not there to disqualify you from being insured. Under the ACA, insurance companies cannot disqualify your or charge you higher rates due to your health. So, it is best to answer them truthfully. Suppose you are taking medications for High Blood Pressure or seeing a doctor for anxiety. In that case, it is best to answer honestly because the engine may provide you with plans that are better suited for one who sees a doctor regularly or one with better prescription coverage. This can aid you in keeping your cost of insurance down.
Understand there are options and assistance for those who find the insurance cost too high. When you apply for health insurance through the Marketplace website, you will find out if you qualify for subsidies that assist you in paying for your premium.
Finding the right health insurance coverage for you is our specialty. This is why we at Cover Mile aim to provide you with the information you need to make an educated decision about your health insurance purchase. Contact us today.