We know health insurance shopping doesn’t top your list of the best ways to spend your time. At CoverMile, we want to help make the process easier, taking the challenging part out of the equation and only showing you the best health insurance plans in Lee County at the best prices. True, we may be outside of Open Enrollment for 2023, but perhaps you may qualify for a Special Enrollment Period. If you are losing coverage from an employer, recently married, or just welcomed a child into your home through birth or adoption, you may qualify. There are also other options open to you, like Short Term Health Insurance.
We at CoverMile want to help you find the best health insurance plans in Lee County, TX, at the lowest prices. Coverage exists for as low as $0 per month. Read on. We can show you how.
2023 Health Insurance Facts in Lee County, Texas
Texas is one of the highest-ranking states when it comes to enrollments. Lee County was ranked within the top 50 of the top 100, for a US News study in 2022. For 2023, Texas saw one of the highest exchange enrollments with 2.4 million. Only Florida beats the Lone Star State.
Texas also holds the uninsured record at 22.1 percent; it has held this position since the exchange system was in its infancy.
Here are additional facts about health insurance in Lee County, Texas.
- Lee County’s population as of July 1, 2022, was 17,954.
- 22.1 percent of county residents do not have health insurance, compared to the 20.7 state average.
- Life expectancy for Lee County is 77.8 years. The national average is 77.5 years.
- Unemployment rate of 4.9 percent, and a poverty rate of 11.5 percent.
- The national median average of smokers is 20.0 percent. Lee County’s average is 18.8 percent.
- Eighty-seven percent of consumers have access to three or more insurers in 2023. This is unchanged from 2022. Through the ACA, Lee County provides access to four insurance providers.
Why Do I Need Health Insurance in Lee County, TX?
Health insurance was once the law of the land. But in 2019, the federal mandate ended. One can legally choose to go without coverage in Texas. However, being without health insurance opens the door to many issues one may not consider.
- Healthcare costs. This is the big one. When you do not have health insurance, you must pay full price. Think of it as having a membership to your favorite retail store. When you show your card, you receive a discounted price. Health insurance acts in the same fashion. Insurance companies contract with medical facilities to provide care to individuals at a negotiated rate.
- Healthcare networks. While you may have a regular doctor, usually called a Primary Care Physician (PCP) and other providers you visit, if you need advanced medical care, having insurance provides you with a connected list of doctors and facilities. This helps ease the concern of where to go, especially since seeking advanced medical care may add stress to an already difficult situation.
- Healthcare maintenance. Having health insurance provides you and those under your plan with free annual checkups and other preventive care services. These services are mandated under the Affordable Care Act. If you do not have a healthcare plan in place, you will have to pay for these benefits out of pocket.
What are My Health Insurance Options in Lee County, Texas?
There is a need for individual and family healthcare in Lee County, Texas. You can purchase through the ACA Marketplace, or you can purchase directly from the health insurance company. There are benefits to each option.
Affordable Care Act/Marketplace – This is the most common option for insurance shoppers. Signing up on the ACA Marketplace is simple. The website guides you to the best option for you and your family, and you will see if you qualify for premium tax credits and subsidies like cost-sharing reductions.
Direct Purchase – If you know you do not qualify for tax credits or subsidies or you prefer to work with an insurance company, you can purchase directly. Rates can vary between on and off-exchange plans. Plans can also differ in their offerings depending on the company and metal tier. If there is a question or doubt, it is always best to purchase through the Marketplace to take advantage of credits and subsidies.
You can contact insurance professionals at CoverMile to assist you with finding the best option for you and your family. We can assist you in determining your eligibility for ACA benefits and applying for health insurance.
Types of Insurance – When you select an insurance plan, whether through the Marketplace or direct purchase, you will see that your plan gives you options; these are called networks. The primary three are HMO, EPO, and PPO. These networks work with facilities and doctors to treat patients. Some companies offer multiple networks, while others, like Blue Cross Blue Shield of Texas, offer only one.
Short-Term Health Insurance – If you need temporary insurance to bridge the gap between today and Open Enrollment or an employer’s benefits package, STH Insurance may be an option for you. This type of health insurance provides temporary basic coverage for routine care. It covers the insured for an initial period of 364 days but can be renewed for an additional 24 months. Be aware that Short Term Health insurance has limitations. It does not cover preexisting conditions, maternity care, or prescription medication.
Top Four Health Insurance Companies with the Highest Star Ratings in Lee County, TX
With many Lee County residents now signing up for health insurance, you may wonder which companies provide the best policies at the most affordable prices. Within Lee County, four health insurance providers offer coverage for residents. All are offered through the ACA Marketplace. These plans are ranked according to their 2023 price increases.
- Blue Cross Blue Shield of Texas – 3.42% increase – While Blue Cross Blue Shield indicates a premium increase for 2023, they continue to show a strong performance from year to year. They offer more plans and choices for shoppers than other insurance companies. Their increase is also the lowest of those we are reviewing.
- Ambetter – 10.7% increase – One disadvantage of Ambetter, other than their premium increase over last year, is the lack of a Bronze metal tier. However, they do have an Adult Dental and Vision benefit with their EPO network option. Other insurance companies only provide the mandated Children’s Dental under the ACA’s 10 Essential benefits.
- Ascension (US Health and Life) – New to exchange. The health insurance market grew again for the fifth consecutive year. The ACA Marketplace welcomed Ascension to the exchange. They offer a zero-dollar premium when tax credits are applied. They offer a zero-dollar virtual PCP visit and a zero-dollar virtual specialist.
Top Six Health Insurance Plans for Lee County, TX
Four health insurance companies offer Lee County residents health insurance. We’ve selected two of the best insurance policies from each of these three companies to review. We have refrained from listing premiums as costs change due to age, family size, and other factors such as tobacco use. They are currently listed from lowest premium to highest.
|Insurance company||Insurance Plan||Co-insurance||Deductible||Out-of-Pocket Max||$0 Virtual Care PCP||$0 Virtual Care Specialist||Adult Dental/ Vision|
|US Health||EPO Personalized Care Standard Gold||25%||$2000/$4000||$8700/$17400||No||Yes||Yes|
|BCBS of Texas||HMO Blue Advantage Bronze||10 %||$8700/$10400||$9100/$18200||Copay applies||No||No|
|US Health||EPO Personalized Care Low Premium Silver||50 %||$3500/$7000||$7250/$14500||No||Yes||Yes|
|Ambetter||EPO Focused Complete||40 %||$5000/$10000||$7250/$14500||Yes||No||No|
|Ambetter||EPO Focused Silver with Adult Vision and Dental||50 %||$5100/$10200||$6300/$12600||Yes||No||No|
|BCBS of Texas||HMO Blue Advantage Silver||40%||$5700/$11400||$7200$14400||Copay applies||No||No|
*Our premium was factored on a Male, Single, 40 years old, non-smoker
How to Enroll in Health Insurance in Lee County, TX?
There is little difference in the enrollment process whether you live in El Paso, Clay, Orange, Nueces, or Lee Counties. Each is bound by Affordable Care Act standards.
When – The Affordable Care Act Open Enrollment period begins on November 1st of each year and ends on December 31st. Your start date will be January 1st. One can also enroll until January 15th, but then your start date will be February 1st.
You can also enroll during a Special Enrollment period. These allow you to enroll anytime during the year. Once qualifies for a SEP for these events:
- Changes in household. – This includes getting married, divorced, birth or adoption, or a death in the family.
- Changes in residence. – If you move out of your zip code, this may require an adjustment to your insurance rate.
- Changes in health coverage. – When you or your spouse lose health coverage provided through an employer or from an alternative source, you can apply for health insurance.
How – The most common method to apply is through the ACA Marketplace website. It is quick, guides you through the process, and gives you an answer as soon as your application is completed. You also receive information if you qualify for tax subsidies. NOTE: You also receive tax subsidy information during the quote process. Before you even submit your application, you have a general idea of how much you will pay for your policy with and without your subsidy.
If you have questions as you shop for health coverage in Lee County, TX, contact CoverMile. We can assist you with finding the best policy that fits your current situation and guide you in signing up for health insurance for you and your family.
How to Find Doctors Near Me in Lee County, TX?
One question most new insurance enrollees have is, which doctors can I see? Each company has their own network of providers and facilities. You can find this information easily by visiting your insurer’s website.
You can search by location, doctor’s name, or facility type.
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.
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.
Find a doctor or facility based on your location, specialty, gender, or other preferences.
Frequently Asked Questions
How much is health insurance in Lee County, TX?
Health insurance cost depends on many factors. Your gender, age, family status, and where you live. Once that is established, each policy has other determiners, such as deductible selected. These will give you your premium cost.
Do I need to wait for Open Enrollment to sign up for health insurance in Lee County, TX?
Under normal circumstances, yes. However, if you have triggered a special enrollment period: a change in your household, a change of employment, or a change in your health care coverage, then you may qualify for health insurance in the middle of the year.
Can I sign up for Oscar Health Insurance in Lee County, TX?
Through our review, we have provided information on health insurance companies that offer health insurance to Lee County, TX. However, Oscar Health Insurance does not offer their policies as part of the Marketplace, nor do they offer plans on the open market in this area.
Can I use my Lee County, TX, health insurance when I am on vacation?
For the most part, health insurance only covers you if you are experiencing a medical emergency. So, the thought of crossing the ocean or a country border for elective surgery because your PCP or specialist won’t authorize it will not suddenly qualify your decision. However, if you have a medical emergency abroad, your policy covers up to the stipulated amount.
Does my Lee County, TX, health insurance cover my medication?
One of the Affordable Care Act 10 Essential Health Benefits is prescription drugs. Insurance companies cover medication at different levels. They are often called tiers, offering from four to six-tier levels. The most popular are Generic, Preferred, Brand, and Specialty.