Hidalgo County is a border county, sharing the Rio Grande with Mexico. It is known for its annual citrus festival in the city of Mission. Folks travel from all over the state to join in the festivities. It is also one of the fastest-growing counties in the country and the most populated outside the Texas Triangle. With such expansion, it opens the door to services such as health insurance. Knowing there are residents in need, orange you glad that CoverMile is here to help you find the best health insurance at a price you can afford?
CoverMile helps individuals and families find the best health insurance coverage at the lowest prices in Hidalgo County, TX. Plans exist for as low as $0 per month with subsidies. Let us show you how.
2024 Health Insurance Facts in Hidalgo County, Texas
Texas had 2.4 million residents enroll in the Affordable Care Act in 2023. The only state with a higher enrollment was Florida. Texas also ranked highest, with the uninsured rate at 22.1 percent. The Lone Star State has held this position since the exchange system was implemented.
Here are additional facts about health insurance in Texas.
- According to a U.S. Census estimate, Hidalgo County’s population is just shy of 890 thousand residents. Of that total, 32 percent are uninsured.
- By gender, of those insured, 50.9 percent are female, and 49.1 percent are male.
- Eighty-seven percent of consumers have access to three or more insurers in 2023. In 2024, through the ACA, Hidalgo County has access to four insurance providers.
- 69.2 percent of Hidalgo County has health insurance. 25.6 percent obtain it with their employer, while 8.83 percent have it through non-group plans. 6.26 percent are on Medicare, 27.7 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.
- The average cost of a Silver health insurance plan in Texas is $475.
- If you miss the annual Open Enrollment period, check if you qualify for Short Term Health Insurance. In Hidalgo County, UnitedHealthcare offers this benefit to residents.
Here are a few fun facts about Hidalgo County itself:
- Hidalgo County was named after Miguel Hidalgo y Costilla. He is known as the father of Mexican Independence. He was a Spanish priest who refused to stand under a French ruler; he was integral to the start of the Mexican War of Independence. While his part in it didn’t last long, his contribution helped Mexico gain its independence in August of 1821.
- While McAllen is the largest city in the county, Edinburg is the county seat.
- The Rio Grande makes up the southern border of the county. It is the border between the United States and Mexico.
- Hidalgo County has the second largest Hispanic population in Texas, behind Bexar County. It is the fifth largest nationwide. However, it is the largest, with over 90 percent Hispanic.
- Hidalgo County has a Texas Citrus Fiesta in Mission. It includes a Fiesta Fun Fair, a product costume show designed with a citrus theme, and a parade of oranges that has been running since 1932.
- Hidalgo County has four ghost towns. Among these are Stockholm, La Lomita, and Edinburg, which once was named Chapin but was voted to change it when its namesake was convicted of murder.
- Hidalgo County shares a border with Mexico with five points of entry: Anzaldua’s, Mc-Allen-Hidalgo International Bridge, Pharr-Reynosa International Bridge, Donna-Rio Bravo, and Progeso-Donna.
- In 2020, Hurricane Hanna caused damage in Hidalgo County. It caused significant flooding in McAllen and Mission.
Do I Need Health Insurance in Hidalgo County, TX?
For this year’s Open Enrollment period, only five states still have health insurance standards. Texas residents aren’t required to have health insurance to see a doctor or visit a health care facility. However, when you don’t have health insurance, you will face issues you may not consider.
- Healthcare costs.When someone presents their membership card at a big box store, they receive a discount. Health insurance is somewhat the same. Medical facilities contract with insurance companies to provide care at a negotiated rate. When you choose not to carry health insurance, you will pay full price.
- Healthcare networks.All Insurance companies provide a list of doctors, specialists, and medical facilities that provide medical care to their subscribers. These lists are known as networks. Networks can ease the concern of searching on your own. Especially since seeking advanced medical care may burden an already stressful situation.
- Healthcare maintenance.Under Affordable Care Act mandates, you receive free preventive care services such as immunizations and well-checkups. Without health insurance, you will need to pay for these services out of pocket.
What are My Health Insurance Options in Hidalgo County, Texas?
Individuals and families in Hidalgo County can purchase health coverage through the ACA Marketplace. You can also buy directly from a health insurance company like Oscar Insurance. Each option has its benefits.
Affordable Care Act/Marketplace – The most common place individuals and families find their health insurance is the ACA Marketplace. When you shop online, you are given a selection of private health insurance companies in Texas. You select the one that best fits your personal and financial situation. The Affordable Care Act website also informs you if you qualify for premium tax credits and subsidies like cost-sharing reductions.
Direct Purchase – When you want to purchase health insurance directly from an insurance company, it’s important to understand you will not have access to ACA subsidies. If you believe you may qualify, apply through the Marketplace website. Also, plans available and insurance rates may vary when making a direct purchase through an insurance company.
Short-term Health Insurance – Short-term insurance may be an option if you only need insurance temporarily. This type of policy is an option when it’s too soon for Open Enrollment and you don’t qualify for a Special Enrollment period, you are still within a probationary period of your employer’s benefit package, or you are nearing Medicare eligibility. Short-term insurance covers an initial period of 364 days and can be renewed for an additional 24 months. Short-term health insurance does have limitations. It doesn’t cover preexisting conditions, maternity care, or prescription medication.
Types of Insurance – Health insurance has three primary network types: HMOs, EPOs, and PPOs. The difference is the network structure. EPOs only allow you to see doctors and use facilities within their network. PPOs are the most lenient on which medical professionals you can see. BCBS of Texas, Aetna, and UnitedHealthcare are HMOs. Ambetter and Oscar are EPOs. When shopping for a plan, watch for out-of-network fees and restrictions. The doctors or specialists you use may not be within all plan networks.
Top Three Health Insurance Companies in Hidalgo 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 this research.
To address this concern, we’ve rated the top companies available in Hidalgo County based on their 2024 rates compared to their 2023 rates.
- Ambetter – 4.39% rate increase. – Ambetter doesn’t offer a Bronze Metal tier, but they include Adult Dental and Vision options with some EPO network plans. Other insurance companies only provide the standard ACA 10 Essential Benefits mandated Children’s Dental and Vision.
- Blue Cross Blue Shield of Texas – 0.24% rate decrease – Last year,BCBS of Texas had a three percent increase. For 2024, they’ll have a slight decrease. They have more plan options available than most insurers and are one of the few companies that are available nationwide.
- UnitedHealthcare – 13.46 % rate increase. – This year, UnitedHealthcare mirrors last year’s performance. While UnitedHealthcare has the second largest premium increase of those surveyed, they offer one benefit other companies on our list don’t—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 Six Health Insurance Plans for Hidalgo County, TX*
Below, we’ve selected each company’s two best health insurance plans for Hidalgo County, TX. They are in order to reflect the cost of a standard Silver policy without cost-saving reductions.
|Copay PCP/ Specialist
|$0 Virtual Care PCP
|Adult Dental/ Vision
|BCBS Of Texas
|Blue Advantage Silver 801 HMO
|Dental/ Vision as separate policies
|BCBS of Texas
|MyBlue Health Silver 705 HMO
|Dental/ Vision as separate policies
|Complete EPO Silver+ Vison+ Adult Dental
|Cost sharing applies
|Silver-E Virtual First HMO
|Dental/ Vision as separate policies
|UHC Silver-E Advantage+ HMO
|Complete Silver HMO
|Dental is reimbursement
*In our review, we have listed three health insurance companies. Other insurance providers may be available.
How to Enroll in Health Insurance in Hidalgo County, TX?
The enrollment process does not change much whether you live in Dallas, El Paso, Hildago, or Orange Counties. Each county must follow Affordable Care Act standards.
When – Open Enrollment for the Affordable Care Act begins on November 1st and continues through January 15th. If you enroll by December 15th, your health insurance begins on January 1st. If you enroll between December 16th and January 15th, your coverage will start on February 1st.
One can enroll anytime outside of Open Enrollment if they qualify for a Special Enrollment Period (SEP). You are eligible for a SEP when there is a change:
- In your household. – This can include a marital status change, having a birth or adoption, or having a death in the family.
- In your residence. – If you move and you switch zip codes, this may trigger an insurance rate adjustment.
- To your health coverage. – When you or your spouse lose employer-sponsored health coverage or a plan from an alternative source, you can apply for health insurance.
How – The easiest way to apply is through the Marketplace. When visiting the Affordable Care Act website, you are guided through entering your personal information. It is quick and easy, and you will know your status as soon as you complete your application. You will also know if you qualify for tax subsidies and how they will apply toward your policy’s cost.
If you have any questions about health insurance in Hidalgo County, TX, contact CoverMile. We can help you find the best coverage that fits your current situation and guide you through the application process.
How to Find Doctors Near Me in Hidalgo County, TX?
One primary concern when insurance shopping is whether you will be able to see your current doctor with your new insurance company. You can find out by visiting the insurance company’s website and searching for your doctor or the facility’s name to see 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.
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.
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.
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.
Frequently Asked Questions
How much is health insurance in Hildago County, TX?
The average cost for a health insurance policy in Texas is $475. Premiums will depend on your age, family size, and the plan you select. Other considerations that can impact premiums are where you live and if you use tobacco products. You can save on your premium if you qualify for tax credits and subsidies.
Can I sign up for Oscar Insurance in Hidalgo County, TX?
No, Unfortunately, Oscar Insurance is not available in Hidalgo County. You can apply for other companies, such as Blue Cross Blue Shield and UnitedHealthcare through the Marketplace. You can also contact CoverMile, and we can assist you with finding the best coverage for you and your family.
Is there a penalty for not having health insurance in Hildago County, TX?
There is no longer a federal or state mandate for health insurance. You can enroll during Open Enrollment from November 1 through January 15th. However, if you choose to remain uninsured, you will pay more for routine health care such as immunizations and well-checkups.
How do I see a doctor without health insurance in Hidalgo County, TX?
It may be difficult to see a doctor without health insurance in Hidalgo County. Most medical facilities require you to have insurance or provide the ability to pay. If you are cash-paying, it’s best to visit a Walk-in Clinic, an Urgent Care facility, or an Emergency Room. Keep in mind that without insurance, the cost of services can be higher. Some may require you to pay upfront. Certain programs exist in Hidalgo County, such as CIHCP (County Indigent Health Care Program), that assist those who cannot afford health insurance and do not qualify for Medicaid.
What happens if I miss the ACA Open Enrollment period in Hidalgo County, TX?
The Affordable Care Act Open Enrollment begins on November 1st and continues through January 15th. If you miss the Jan 15th deadline, you must have a qualifying event to enroll in a Marketplace insurance plan. A Special Enrollment Period can include getting married, recently losing a job that provided benefits, or adding a child to your family through birth or adoption.
Can I purchase ACA insurance if my employer offers benefits in Hidalgo County, TX?
The short answer is yes. You can sign up for an Affordable Care Act insurance plan if you decline an employer’s health insurance. However, most likely, you will not qualify for subsidies. If your employer’s plan meets the standard of being affordable and provides minimum standards, you will not be eligible for tax subsidies, meaning you must pay full price for your health insurance.
Are there out-of-pocket expenses for my Hidalgo County, TX, health insurance?
After you pay your premium, you must meet your deductible. Each insurance policy will be different. Expenses above your deductible will include copays and prescription costs.
Am I able to get Dental or Vision Insurance in Hidalgo County, TX?
Due to the Affordable Care Act 10 Essential Benefits, all health insurance plans include Children’s Dental and Vision, but they are limited. Also, these plans exclude adults. Ambetter and United HealthCare offer Adult Dental and Vision on select plans. Our review above includes options. Most other companies offer them, like Blue Cross Blue Shield, but they are offered separately from their health insurance plans. Visit their website for more information.