Health Insurance Plans in Fayette County, Texas 2024

What do Dolly Parton, ZZ Top, and La Grange, Texas all have in common, and how does health insurance tie into it? Well, if you are a film buff, you must know that the answer is The Best Little Whorehouse in Texas. Dolly starred in the movie, La Grange is a song about the town, and the city is the setting of the film and song. As for insurance, Fayette County is the backdrop of it all. We know that shopping doesn’t top your list of the best way to spend your time, but perhaps relaxing into it may help a little. At CoverMile, we aim to help the process easier, showing you the best health insurance plans at the best prices in Fayette County.

While we may be out of Open Enrollment for 2023, you may have recently experienced a Special Enrollment Period you may be unaware of. If you have lost a job, are recently married, or have had a birth or recent adoption, you may qualify. There are also other options for health insurance, such as Short-Term Health insurance. Read on to find out.

2023 Health Insurance Facts in Fayette County, Texas

Texas is one of the highest-ranking states for health insurance enrollments. Fayette County was ranked among the top 50 of the top 100 in a 2022 US News study. For 2023, Texas saw one of the highest exchange enrollments, with 2.4 million individuals. Only Florida beat 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 Fayette County, Texas.

  • Fayette County’s population as of July 1, 2022, was 24,931.
  • By gender, those insured are 47.8% men and 52.2% women.
  • 21.6 percent of county residents do not have health insurance, compared to the 20.7 state average.
  • Primary care physicians see, on average, 3169 patients per year.
  • Eighty-seven percent of consumers have access to three or more insurers in 2023. This is unchanged from 2022. Currently, through the ACA, Fayette County has access to four insurance providers.
  • Unemployment rate of 4.7 percent, and a poverty rate of 11.5 percent. Many families do not have access to health insurance through their jobs.
  • The national median average of those who smoke is 20.0 percent. Fayette County’s average is 17.9 percent.
  • Life expectancy in Fayette County is 79.4 years. The national average is 77.5 years.

Why Do I Need Health Insurance in Fayette County, TX?

The Affordable Care Act was established for Americans to have access to health care in the United States. It once had been a federal mandate. However, in 2019, the law was overturned, and one can now legally choose to go without coverage in Texas. This can open the door to many issues one may not consider.

  1. Healthcare costs. This can be significant. When you don’t 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.
  2. Healthcare networks. While you may have a Primary Care Physician or other providers you visit, if you need advanced medical care, having insurance provides you with a 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.
  3. Healthcare maintenance. Having health insurance provides you and those under your plan with preventive care services such as free annual checkups and physicals. These services and more 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 Fayette County, Texas?

There is a need for individual and family healthcare in Fayette 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/MarketplaceThis is the method most individuals use to find health insurance in Texas. Signing up on the ACA Marketplace is simple. The website takes you through the steps to purchase the best insurance option for you and your family. You can also see if you qualify for premium tax credits and subsidies like cost-sharing reductions.

Direct PurchaseIf you already know you do not qualify for subsidies or you prefer to work with an insurance company, you can purchase directly. Rates can vary when you purchase off-exchange plans. They can also differ in what they offer, depending on the company and metal tier. If you have questions or doubts, it is always best to purchase through the Marketplace to take advantage of possible 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 – Whether purchasing your insurance through the Marketplace or direct purchase, you will find that your plan gives you options; these are called networks. The primary three are HMO, EPO, and PPO. These networks contract with facilities and doctors to treat patients. Some health insurance companies offer multiple networks, while others, like Blue Cross Blue Shield of Texas, offer only one.

Short-term Health InsuranceShort Term Insurance is health insurance that provides basic health insurance for a specific period of time. It can help those who are uninsured, outside of Open Enrollment and do not qualify for a Special Enrollment Period. 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 Three Health Insurance Companies with the Highest Star Ratings in Fayette County, TX

With Texas holding the top spots for both the insured and uninsured rates, residents can take advantage of the companies that offer the lowest rates whether they are searching for a plan on the ACA marketplace or directly from a health insurance provider. Currently, three healthcare providers offer coverage to Fayette County residents.

We have listed them below according to their most recent premium increase and then by their current premium, highest to lowest.

  • Blue Cross Blue Shield of Texas – 3.42% increase – This increase is the lowest of those we are reviewing. While Blue Cross Blue Shield had a premium increase for 2023, they continue to show a strong performance year after year. They offer more plans and choices than other insurance companies.
  • Ambetter – 10.7% increase – One disadvantage Ambetter has is the lack of a Bronze metal tier. However, having an EPO network Adult Dental and Vision benefits gives them an advantage over other insurance companies that only provide the mandated Children’s Dental under the ACA’s 10 Essential benefits.
  • Ascension (US Health and Life) – New to exchange. The ACA Marketplace added more companies for the fifth consecutive year. They welcomed Ascension to the exchange. They offer a zero-dollar premium when tax credits are applied. They also provide a zero-dollar Virtual PCP visit and a zero-dollar Virtual Specialist on select plans.

Top Six Health Insurance Plans for Fayette County, TX

Three health insurance companies offer Fayette 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 companyInsurance PlanCo-insuranceDeductibleOut-of-Pocket Max$0 Virtual Care PCP$0 Virtual Care SpecialistAdult Dental/ Vision
US HealthEPO Personalized Care Standard Gold25%$2000/$4000$8700/$17400NoYesYes
BCBS of TexasHMO Blue Advantage Plus Bronze   50 %$6100/$17400$9100/$18200Copay appliesNoNo
US HealthEPO Personalized Care Low Premium Silver50 %$3500/$7000$7250/$14500NoYesNo
AmbetterEPO Clear Gold30 %$900/$1800$8700/$17400YesNoNo
AmbetterEPO Complete Gold with Adult Vision and Dental20 %$1450/$2900$7500/$15000YesNoYes
BCBS of TexasHMO Blue Advantage Silver40%$5700/$11400$7200$14400Copay appliesNoNo

*Our premium was factored on a Male, Single, 40 years old, non-smoker

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

There is little difference in the enrollment process whether you live in El Paso, Cooke, Orange, Hidalgo, or Fayette Counties. All are bound by Affordable Care Act standards.

WhenThe 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 you can qualify for 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.

HowThe 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 quotation process. Before you 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 Fayette 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 Fayette County, TX?

One of the biggest concerns people have when shopping for insurance is which doctors they can see. Each insurance company contracts with its own network of providers and facilities. When you live in a smaller area, some companies have extended networks that will include the larger cities. Living in Fayette County your network may have access to health insurance providers in Austin. Visit the insurer’s website to learn more information.

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.

US Health and Life

Find a doctor or facility based on your location, specialty, gender, or other preferences.

Frequently Asked Questions

  1. How much is health insurance in Fayette County, TX?

    How much you will pay for your health insurance will depend on several factors: age, gender, marital status, if you have children, and where you live are all contributors. The deductible you select will also greatly impact how much your premium will be.

  2. When is Open Enrollment for health insurance in Fayette County, TX?

    Open Enrollment will begin on November 1, 2023, and run through December 31 for a January 1st start date. You can also enroll late, through January 15th. Your health insurance will begin then on February 1st. You can also apply for insurance in the middle of the year if you qualify for a Special Enrollment Period. This can be a change in status of your household, a change to your employment situation, or a change in your health coverage source.

  3. Can I purchase Oscar Health Insurance in Fayette County, TX?

    We have provided information on three health insurance companies in Texas that offer policies in Fayette County. However, Oscar Health Insurance does not provide policies within the ACA marketplace, nor do they offer plans on the open market.

  4. Can I use my Fayette County, TX, health insurance if I travel to another state?

    If you are experiencing a medical emergency, all health insurance policies will provide coverage. However, if you are seeking treatment for a non-urgent matter, you most likely will not have coverage. This includes seeking treatment in a foreign country because you cannot get a referral in the States.

  5. Does my health insurance cover my medication in Fayette County, TX?

    Prescription drugs are one of the Affordable Care Act 10 Essential Health Benefits. 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.