Health Insurance Plans in Harris County, Texas, 2024

If you are a sports fan, Harris County does not leave you wanting in terms of teams to root for. Most famously is the Houston Astros. In recent years, one would need a doctor from the edge of your seat, breath-taking, heart-pounding games. I guess it’s good we are talking about health insurance in Harris County. Through this guide, we aim to show you what companies offer insurance and give you examples of plans available to you. And unlike the crew of Apollo 13, you won’t have a problem finding health insurance with CoverMile at your side.

CoverMile is here to help you find the best health insurance coverage at the lowest prices in Harris County, TX. Plans exist for as low as $0 per month with subsidies. Read on, and we can show you how.

2023 Health Insurance Facts in Harris County, Texas

Texas has held one of the highest ACA enrollments in the country, with 2.4 million for 2023. Only Florida has a higher enrollment rate. Texas also has the highest uninsured rate in the country, at 22.1 percent. It has held that position since the implementation of the exchange system.

Here are additional facts about health insurance in Texas.

• According to a U.S. Census estimate, Harris County has a population of 4.8 million residents. Of that total, 18.9 percent are uninsured.
• By gender, of those insured, 48.7 percent were men, and 51.3 percent were female.
• Eighty-seven percent of consumers have access to three or more insurers in 2023. This is unchanged from 2022. Through the ACA, Harris County has access to eight insurance providers.
• 78.9 percent of Harris County have health insurance. 44.1 percent obtain it with their employer, while 9.56 percent have it through non-group plans. 7.81 percent are on Medicare, 16.5 percent have insurance through Medicaid, and less than one percent have insurance through the V.A. or military.
• Fifty-nine percent of consumers have access to a plan from a national insurer; companies like Blue Cross Blue Shield of Texas and UnitedHealthcare are available to more than just a local area.
• According to Niche, Harris County is one of the Healthiest County in Texas for 2023. They also voted it one of the best counties for families to live in.
• Primary care physicians in Harris County, TX, see, on average, 1691 patients per year; dentists, 1391 patients per year; mental health providers, 731 patients per year.
• The average cost for a Silver health insurance plan in Texas is $454
• If you are outside of Open Enrollment, you may qualify for Short Term Health Insurance. Some insurers offer this benefit. UnitedHealthcare is one of them.

Here are a few fun facts about Harris County itself:

• Harris County was named after John Richardson Harris. He was a settler and founder of Harrisburg, later renamed to Harris County, TX. He moved to Texas and received the title to land at the junction of Buffalo and Bray’s Bayou.   

• Harris County has the world’s largest medical complex, employing over 106K employees.
• Harris County’s coastal region rests on many bays, Trinity, Burnet, and San Jacinto. These feed from Bear Lake, Buffalo Bayou, Carpenters Bayou, and the San Jacinto River.
• On August 25^th, 2017, Hurricane Harvey, a Category 4 storm, made landfall in southeast Texas. For areas like Harris County, it saw tremendous flooding and destruction. Buffalo Bayou saw 35 inches of rain. Since then, many smaller storms have hit the city; the strongest was Nicholas, a Category 1 hurricane in 2021.
• Harris County is home to the Lyndon B Johnson Space Center. The infamous call, “Houston, we’ve had a problem,” was spoken to ground control there. Although then it was called Manned Spacecraft Center. It was renamed in 1973.
• Harris County is home to baseballs, Houston Astros; NFLs, Houston Texas; basketballs, Houston Rockets; and Major League Soccer’s Huston Dynamo SC.
• Even with a major city like Houston, Harris County still has 12 ghost towns. Among these are Brunner, Goose Creek, Lynchburg, and Moonshine Hill, a small town lost due to the flooding of the San Jacinto River in 1994.

Do I Need Health Insurance in Harris County, TX?

Texas no longer has a federal mandate to carry health insurance. Only a few states still require residents to have health coverage. While you do not need insurance to visit a doctor or health facility, choosing not to insure yourself and your family opens the door to issues you may not consider.  

1. Healthcare costs.When you do not carry health insurance, you need to pay full price. Consider health insurance as having a membership card to your favorite big box store. When you present your card, you receive a discounted price. Health insurance acts the same way. Insurance companies contract with medical facilities to provide care at a negotiated rate.
2. Healthcare networks.Having insurance provides you with a list of specialists and medical facilities should you need treatment beyond your normal doctor. This helps ease the concern of searching on your own. Especially since seeking advanced medical care may burden an already stressful situation.
3. Healthcare maintenance.Under the Affordable Care Act, certain services are mandated. Having health insurance provides free annual checkups and other preventive care services. When you choose not to carry health insurance, you must pay for these services out of pocket.

What are My Health Insurance Options in Harris County, Texas?

Texans have several options for affordable health insurance. Individuals and families can find healthcare coverage in Harris County through the ACA Marketplace or directly from the health insurance company. Each option has its benefits.

Affordable Care Act/Marketplace – Purchasing through the Marketplace is the most common option. When you sign up online, you will be shown the best options available to you and your family. The ACA website will also inform you if you qualify for premium tax credits and subsidies like cost-sharing reductions.

Direct Purchase – The first thing to understand about a direct purchase is you will not have access to ACA subsidies. If you are unsure if you qualify, you should first apply on the Marketplace website before you begin your insurance shopping. Also, know that plans and rates may vary when you shop on and off-exchange.

Short-term Health Insurance – Short-term insurance may be an option if you need health insurance between the date of hire and your employer’s benefits package, it is too long before Open Enrollment and you don’t qualify for a Special Enrollment period, or you are nearing Medicare. This policy covers an initial period of 364 days and can be renewed for an additional 24 months. Understand that Short-term health insurance has limitations. It does not cover preexisting conditions, maternity care, or prescription medication.

Types of Insurance – The primary three health insurance network types are HMOs, EPOs, and PPOs. The primary difference is the network structure. EPOs are the strictest. PPOs are the most lenient on which doctors you can see and when. When shopping for a plan, be cautious about out-of-network fees should the doctors or specialists you may use not be within your plan’s network. BCBS of Texas, Aetna, and UnitedHealthcare are all HMOs. Ambetter and Oscar are EPOs.

Top Five Health Insurance Companies in Harris County, TX

What a customer is willing to pay for their policy over time is one of the main details top insurance ratings evaluate. Health insurance shoppers then use reviews to consider which insurance companies are best and purchase based on their research.

To address this concern, we’ve rated the top companies available in Harris County based on their 2023 rates compared to their 2022 rates.

• Aetna – 6.92 % rate decrease – We begin with one of the only companies that have seen a decrease. And a decent increase at that. They are known for their $0 preventive care, 24/7 $0 Virtual Care, and in-network $0 walk-in clinics available seven days a week.
• Blue Cross Blue Shield of Texas – 3.42% rate increase – Although BCBS of Texas rates have increased in 2023, they’ve proven to be a strong and reliable insurance provider. They have more plans available than other insurers, giving you and your family options. They are also available nationwide.
• ·      Ambetter – 10.7% rate increase – Ambetter does not offer a Bronze Metal tier. However, they offer an Adult Dental and Vision option with some EPO network plans. Other insurance companies only provide the ACA 10 Essential Benefits mandated Children’s Dental.  
• Oscar – 10.9% rate increase –Oscar Insurance offers benefits other companies lack. First is a $3 copay for prescriptions on some plans. Second, they offer $0 Virtual Specialist Visits. Most companies only include virtual visits for a Primary Care Physician visit.

• UnitedHealthcare – 13.46 % rate increase – While UnitedHealthcare for Harris County has the largest premium increase for 2023, they offer benefits that other companies on our list don’t. One is Short Term Insurance. If you are without insurance, it’s between Open Enrollment, and you don’t qualify for a Special Enrollment Period, UnitedHealthcare may be your only option.

Top Seven Health Insurance Plans for Harris County, TX*

Below, we’ve selected each company’s best insurance policies for Harris County, TX. They are in order as they reflect the cost of a standard policy without Cost Saving reductions.

Insurance company	Insurance Plan	Co-insurance	Deductible	Out-of-Pocket Max	Copay PCP/ Specialist	$0 Virtual Care PCP	Adult Dental/ Vision
BCBS of Texas	MyBlue Health Silver 807 HMO	40%	$5700/ $11400	$7200/ $14400	$40/$80	Fee Applies	Dental/ Vision as separate policies
Aetna	Complete VALUE Silver HMO	40%	$5000/ $10000	$7550/ $15100	$20/$50	Yes	Dental as separate policy
Oscar	Simple Specialist Saver EPO 250	50%	$4500/ $9000	$7200/ $14400	$40/$40	Yes	No
United Healthcare	Silver-E Standard HMO	40%	$5700/ $11400	$7200/ $14400	$30/$60	$30 Copay	Dental/ Vision as separate policies
BCBS Of Texas	Blue Advantage Silver 801 HMO	40%	$2500/ $5000	$7550/ $15100	$45/$80	Fee Applies	Dental/ Vision as separate policies
Ambetter	Standard Silver EPO	40%	$5700/ $11400	$7200/ $14400	$40/$80	Yes	Yes
Ambetter	Complete EPO Silver+ Vison+ Adult Dental	40%	$5000/ $10000	$7500/ $10000	$20/$50	Cost sharing applies	No

*In our review, we have listed five health insurance companies. Other insurance providers may be available.

How to Enroll in Health Insurance in Harris County, TX?

There is not much difference in the enrollment process whether you live in Dallas, El Paso, Corpus Christi, or Harris Counties. Each county must follow the Affordable Care Act standards.

When – The Affordable Care Act Open Enrollment begins on November 1^st and ends on December 31^st. Your insurance starts on January 1^st. You also have a late enrollment period. This gives you until January 15^th to enroll, but your start date will be February 1^st.

The ACA also allows Special Enrollment Periods (SEP), where one can enroll anytime during the year. You qualify for a SEP when:

• There is a change in your household. – This can include getting married or divorced; having a birth or adoption; or having a death in the family.
• You have a change in your residence. – If you move out of your zip code, this may require an adjustment to your insurance rate.
• You have a change to your health coverage. – When you or your spouse lose health coverage provided through an employer or an alternative source, you can apply for health insurance.

How – The easiest way is through the ACA Marketplace. It is quick, and the website guides you through the process. You will also receive an answer as soon as you complete your application. You will also know if you qualify for tax subsidies. If you do, it will factor your savings into your policy’s cost.

If you have any questions when searching for health insurance in Harris County, TX, contact CoverMile. We can assist you with finding the best coverage that will fit your current situation and guide you through the health insurance sign-up process.

How to Find Doctors Near Me in Harris County, TX?

One primary concern of insurance shoppers is if a doctor is on the insurance’s list of doctors they will be able to see. You can find out easily by visiting the insurer’s website and searching for your doctor’s or the facility’s name. This search will tell you if they are in-network or out-of-network.

The links below will take you to each provider’s website and directory. You can search by location, doctor’s name, and facility type. Each website is different, and some offer more information than others.

Blue Cross Blue Shield of TX

After entering your location, you can search Medical Care, Urgent Care, Behavior Health, and Cost Estimates. You can also search for pharmacy information, as well as for dental and Vision care.

Oscar

Once you select your plan, you can find Primary Care Providers (PCPs), hospitals, pharmacies, and urgent care centers in your area.

Ambetter

Enter your plan information and location, and you can find doctors and facilities in your area. You are also given the option to connect with Telehealth or to talk with a nurse directly.

UnitedHealthcare

Begin by selecting the type of provider you are searching for, then your plan type, and finally, the plan you are on. Then, you can search by doctor, facility, specialty, or condition. You can also view a cost estimate.

Aetna

After providing your zip code and the search parameters, select your health plan. Then, you can search for doctors, facilities, and pharmacies in your selected area.