Health Insurance Plans in Travis County, Texas 2024

Travis County, especially the city of Austin, is filled with historical significance. Many landmarks, called Houses, are where people of influence once lived. Joseph Fischer, a famous mason, and William Sydney Porter, better known as writer O. Henry, have Houses named after them. Speaking of things named after them, Dr. Arthur C. Scott and Dr. Raleigh R. White, after their passing and years of dedication to the field, have a health insurance company named after them, Baylor, Scott, and White. We discuss this company and six others that provide health insurance to Travis County, Texas residents. Let’s take a look.

We at CoverMile are here to help you find the best health insurance plans in Travis County, TX, at the lowest prices. Coverage exists for as low as $0 per month with subsidies. Read on, and we can show you how.

2023 Health Insurance Facts in Travis County, Texas

The Texas health insurance market is unique. It has one of the highest exchange enrollments in the country, with 2.4 million for 2023. Only Florida beats it. Texas also holds the highest uninsured rate in the country at 22.1 percent. It has held that position since the exchange system was implemented.

Here are additional facts about health insurance in Texas.

• According to a US Census estimate, Travis County has a population of 1.3 million residents. Of that total, 16.5 percent are uninsured. That’s almost 215 thousand individuals.
• By gender, those insured 49.9 percent were men, and 50.1 percent were female.
• Eighty-seven percent of consumers have access to three or more insurers in 2023. This is unchanged from 2022. Currently, through the ACA, Travis County has access to seven insurance providers.
• Fifty-nine percent of consumers have access to a plan from a national insurer; these are companies like Blue Cross Blue Shield of Texas, that are available to more than just a local area.
• According to Niche, it voted Travis County as the Healthiest County in Texas for 2023. They also voted it as the third-best county to live in.
• Primary care physicians in Travis County, TX, see, on average, 1158 patients per year; dentists, 1385 patients per year; mental health providers, 343 patients per year.
• The national median average of those who smoke is 20.0 percent. Travis County’s average is 12.0 percent.
• Life expectancy in Travis County is 81.5 years. The national average is 77.5 years.
• 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.

Do I Need Health Insurance in Travis County, TX?

Health insurance for all is no longer a federal mandate. Only a handful of states require an individual to carry health insurance. Texas is not one of them. However, if you choose not to insure yourself and your family, it opens the door to many issues you may not consider.

1. Healthcare costs. This is the big one. When you do not carry health insurance, you need to pay full price. Think of health insurance as having a membership card to your favorite big box store. When you show your card, you receive a discounted price. Health insurance acts the same way. Insurance companies contract with medical facilities to provide care to individuals at a negotiated rate.
2. Healthcare networks. While you may receive treatment from your regular doctor or provider, should you need to see a specialist, having insurance provides you with a list of doctors and facilities. This helps ease the concern of searching on your own. Especially since seeking advanced medical care may add burdens to an already stressful situation.
3. Healthcare maintenance. Having health insurance provides you and those under your plan with free annual checkups and other preventive care services. Under the Affordable Care Act, these services are mandated. When you choose not to carry health insurance, you will have to pay for these services out of pocket.

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

Individuals and families need healthcare in Travis County. There are several options to find affordable health insurance in Texas. You can purchase through the ACA Marketplace or directly from the health insurance company. There are reasons to select each option.

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

Direct Purchase – The first thing you need to know is that when you purchase from an insurance company directly, you will not have access to ACA subsidies. So, if you believe you qualify for either, your best bet is to apply on the Marketplace site. Also, know that rates may vary between on and off-exchange plans. What a plan offers can also change depending on the insurance company and metal tier.

Types of Insurance – When you select an insurance plan, whether through the Marketplace or Direct purchase, the insurance company may allow you to choose your insurance network. The primary three you will see are HMOs, EPOs, and PPOs. While these network types are different, each insurance company chooses which network type or types they will contract with and make available to their customers. However, when shopping for a plan be cautious because of out-of-network fees should the doctors or specialists you may see not be within your plan’s network.

Short-term Health Insurance – If you need temporary insurance to bridge the gap until Open Enrollment or your employer’s benefits start date, Short Term Insurance may be an option. This type of policy provides temporary basic health coverage for routine care. It 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.

Top Seven Health Insurance Companies with the Highest Star Ratings in Travis County, TX

With the growth of those signing up for health insurance in Travis County, Texas, it becomes a question of which company you should select for yourself and your family. It begins with how much each company charges enrollees. For 2023, this is how each of the seven providers matches up compared to their 2022 rates.

• Aetna – 6.92 % 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.
• Baylor, Scott, and White – 1.7% increase –  With only a minor increase over 2022, Baylor, Scott, and White have merged with Bright Healthcare and Friday Health Plans. Both companies had been on the ACA Marketplace list in 2022.
• Blue Cross Blue Shield of Texas – 3.42% increase – Although BCBS of Texas has had an increase in 2023 over 2022, they have proven to be a stronger and most reliable insurance provider over the years. They have more plans available than other insurers; this means you have options for you and your family.
• ·      Ambetter – 10.7% increase – Ambetter does not offer a Bronze metal plan. However, they have an Adult Dental and Vision option with some of their EPO network plans. Other insurance companies only provide the mandated Children’s Dental that is part of the ACA’s 10 Essential benefits.
• Oscar – 10.9% increase –Oscar Insurance has options that other companies lack. One is a $3 copay for prescriptions on some plans. They also offer $0 Virtual Specialist Visits. Most companies only include virtual visits for a Primary Care Physician visit.

• UnitedHealthcare – 13.46 % increase – While UnitedHealthcare for Travis County residents has the largest premium increase for 2023, they offer benefits the other companies on our list don’t offer. One is Short Term Insurance. If you are without insurance, and you need it now to get you to Open Enrollment and don’t qualify for a Special Enrollment Period, UnitedHealthcare may be your only option.
• Ascension (US Health and Life) – New to exchange. Being new to the Marketplace, it is difficult to determine how they will match up. However, US Health and Life offers Travis County plans that offer a zero-dollar premium with tax credits applied. Like Oscar, they offer access to virtual doctors and specialists. They also provide plan levels for American Indians and Alaskan Natives.

Top Seven Health Insurance Plans for Travis County, TX

Below we’ve selected the best insurance policies for Travis County, TX, from each of the above companies. 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	Blue Advantage Plus Bronze HMO	50%	$6100/ $17400	$9100/ $18200	40%/50%	Fee Applies	Dental/ Vision as separate policies
Aetna	Aetna Silver 2 HMO	40%	$4000/ $8000	$6800/ $13600	$25/$50	Yes	Dental as separate policy
US Health	Personalized Care Low Premium Silver EPO	50%	$3500/ $7000	$7250/ $14500	$30/$60	Copay Applies	No
Baylor Scott and White	Prime Silver HMO	40%	$3400 $6800	$7250/ $14500	$30/$70	Fee Applies	No
United Healthcare	Silver-E Standard HMO	40%	$5700/ $11400	$7200/ $14400	$30/$60	$30 Copay	Dental/ Vision as separate policies
Oscar	Silver-Simple PCP Saver EPO	40%	$4750/ $9500	$7200/ $14400	$20/$80	Cost sharing applies	No
Ambetter	Focused Silver HMO	50%	$5100/ $10200	$630/ $12600	$35/$85	Yes	Yes

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

There is not much difference in the enrollment process whether you live in Travis, El Paso, Corpus Christi, or Dallas Counties. Each is bound by Affordable Care Act standards.

When – The Affordable Care Act Open Enrollment period begins on November 1^st of each year and ends on December 31^st. Your insurance will then begin on January 1^st. You also have until January 15^th to enroll, but your start date will be February 1^st.

There are also 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 in your family; or there is 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 from an alternative source, you can apply for health insurance.

How – The most common way is through the Affordable Care Act Marketplace website. It is quick and guides you through the process. It also gives you an answer as soon as you complete your application. It will also inform you 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 shopping for health insurance in Travis County, TX, contact CoverMile. We can assist you with finding the best coverage that will fit your current situation. We can guide you through the health insurance sign-up process.

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

When you are insurance shopping, one of your primary concerns is if your doctor will be on the insurance’s list of doctors you 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 will be able to find out if your doctor or the facility you frequent is covered. 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 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 your 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.

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.

Baylor, Scott, and White

You begin by selecting your plan type. Then you can choose the type of specialty you are searching for, then your zip code. The search engine will show you all available doctors and facilities in that area based on the parameters you set up.

Aetna

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