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.
- 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.
- 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.
- 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 1st of each year and ends on December 31st. Your insurance will then begin on January 1st. You also have until January 15th to enroll, but your start date will be February 1st.
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.
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.
Once you select your plan, you can find Primary Care Providers (PCPs), hospitals, pharmacies, and urgent care centers in your area.
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.
Find a doctor or facility based on your location, specialty, gender, or other preferences.
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.
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.
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.
Frequently Asked Questions
How much is insurance in Travis County, TX?
As we noted earlier, the average health insurance plan in Texas is $454. This price will vary, though. Insurance cost depends on your age, family size, and other factors, such as what type of plan you select, where you live, and if you use tobacco products. How much you will pay will also be determined by qualification for tax credits and subsidies.
Do I need to wait for Open Enrollment to sign up for health insurance in Travis County, TX?
The quick answer to this question is, yes, you usually have to wait for the November 1st – December 31st Open Enrollment period to apply for health insurance in Texas. However, if you meet certain criteria, you may qualify for a Special Enrollment Period. These can include you got married, the loss of a job that you had benefits, or the birth or adoption of a child.
Can I sign up for Oscar Insurance in Travis County, TX?
Yes, Oscar Insurance is available in Travis County. You can apply through the Marketplace or visit their website and apply for one of their off-marketplace plans. You can also contact CoverMile, and we can assist you in applying for coverage. Oscar Insurance is known for their $3 prescriptions on some of their plans as well as their Virtual Urgent Care.
Can I use my Travis County, TX, health insurance when I travel?
With many health insurance plans, you are only able to use your health insurance within your local network. However, in the event of an emergency, your policy allows you to be seen at a hospital or other medical facility. Review your policy, or call your insurance company to see if you need to do anything if you plan to travel abroad.
Is there a penalty for not having health insurance in Travis County, TX?
No. The health insurance mandate in Texas was voted down in 2019. There is no longer a penalty for not carrying health insurance in Travis County or the state of Texas. However, Texas does not follow the federal guidelines for the poverty level. It is one of the six states that follow their own statutes. With no access to Medicaid or Market subsidies, one is left with purchasing insurance out of pocket, or going without.
Does my Travis County, TX, health insurance cover my medication?
All Marketplace health insurance plans are mandated to cover medications as outlined by the Affordable Care Act. However, there is no stipulation on how much each insurer can charge. Each insurance plan has a different coverage level depending on the plan and the metal level.
Are there options to the Marketplace in Travis County, TX?
In addition to purchasing health insurance in Austin through the Marketplace, one can purchase their insurance plan directly from the insurance company on their website. If you are lower income, you can apply for insurance through the ACA website. If you qualify, you will be given notification about Medicaid. Finally, if you are within six months of your 65th birthday, you can begin the process of applying for Medicare. You can also purchase short term health insurance.