Texas Health Insurance Quote

Individual Texas health insurance

Individual health insurance in Texas is changing rapidly. Twenty-five years ago, most people had indemnity insurance coverage. A person with indemnity insurance could go to any doctor, hospital, or other provider (which would bill for each service given), and the insurance company and the patient would each pay part of the bill.

But today, the majority of people with individual Texas health insurance are enrolled in some kind of managed care plan, an organized way of both providing services and paying for them. Different types of managed care plans work differently and include preferred provider organizations (PPOs), health maintenance organizations (HMOs), point-of-service (POS) plans, and one of the newest, most innovative plans in over 60 years: health savings accounts (HSAs).

You've probably heard these terms before. But what do they mean? What are the differences between them, and what do these differences mean to you?

It’s important to understand what kind of protection your individual Texas health insurance plan provides and what you will need to do to get the health care that you need. The more you learn, the more easily you'll be able to decide what fits your personal needs and budget.

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Individual Health Insurance in Texas – What are my options?

Choosing an individual Texas health insurance plan is not as easy as it once was. Although there is no one "best" plan, there are some plans that will be better than others for your health needs. Plans differ, both in how much you have to pay and how easy it is to get the services you need. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others.

Almost all plans today have ways to reduce unnecessary uses of health care and to keep costs down. This may affect how easily you get the care you want, but should not affect how easily you get the care you need. Plans change from year to year, so you should carefully consider each plan and review new options annually.

Individual health insurance in Texas is usually described as either indemnity (fee-for-service) plans or managed care plans. These types of plans differ in important ways that are described below. With any health insurance plan, however, there is a basic premium, which is how much you pay, usually monthly, to buy health insurance coverage. In addition, there are often other payments you must make, which will vary by plan. In considering any plan, you should try to figure out its total cost to you based on how you use your benefits.

Indemnity Plans

With an indemnity plan (sometimes called fee-for-service), you can use any medical provider (such as a doctor and hospital). You or they send the bill to the insurance company, which pays part of it. Usually, you have a deductible to pay each year before the insurer starts paying.

Once you meet the deductible, most indemnity plans pay a percentage of what they consider the "Usual and Customary" charge for covered services. The insurer generally pays 80 percent of the Usual and Customary costs and you pay the other 20 percent, which is known as coinsurance. If the provider charges more than the Usual and Customary rates, you will have to pay both the coinsurance and the difference.

The plan will pay for charges for medical tests and prescriptions as well as from doctors and hospitals. It may not pay for some preventive care, like checkups.

Managed Care Options

A Preferred Provider Organization (PPO) is a form of managed care closest to an indemnity plan. A PPO has arrangements with doctors, hospitals, and other providers of care who have agreed to accept lower fees from the insurer for their services. As a result, your cost sharing should be lower than if you go outside the network. In addition to the PPO doctors making referrals, plan members can refer themselves to other doctors, including ones outside the plan.

If you go to a doctor within the PPO network, you will pay a copayment (a set amount you pay for certain services – say $25 for a doctor visit or $10 for a prescription). Your coinsurance will be based on lower charges for PPO members.

If you choose to go outside the network, you will have to meet the deductible and pay coinsurance based on higher charges. In addition, you may have to pay the difference between what the provider charges and what the plan will pay.

Health Savings Accounts (HSAs) are the newest, most innovative form of a managed care plan. HSAs offer members more control over their health benefits, while typically reducing premiums 25-40%. HSA plans combine a qualified high-deductible health plan with a tax-favored saving account allowing individuals to provide virtually 100% coverage for their entire medical, dental and vision needs. Most plans include preventive care options that allow additional coverage for all routine wellness visits on an annual basis.

HSAs offer the flexibility to visit any doctor you choose, but most do provide a PPO network to help maximize your out-of-pocket expenses. This gives you, the consumer, the maximum flexibility to receive the care you need, when you need it.

To learn more about how HSAs work and whether an HSA may be right for you, read "How HSAs work."

A Point-of-Service (POS) Plan is an indemnity-type option offered by HMOs. The primary care doctors in a POS plan usually make referrals to other providers in the plan. But in a POS plan, members can refer themselves outside the plan and still get some coverage.

If the doctor makes a referral out of the network, the plan pays all or most of the bill. If you refer yourself to a provider outside the network and the service is covered by the plan, you will have to pay coinsurance.

Click here for Free Instant Quote or call now to speak with a licensed health insurance expert.
Agents are available to help you M-S 8 am to 6pm CST at 877-749-2241

Individual Health Insurance in Texas – What Benefits Are Offered?

Most plans provide basic medical coverage, but the details are what counts. The best individual Texas health insurance plan for someone else may not be the best plan for you. For each plan you are considering, find out how it handles:

• Physical exams and health screenings.
  
• Care by specialists.
  
• Hospitalization and emergency care.
  
• Prescription drugs.
  
• Vision care.
  
• Dental services.

Also ask about:

• Care and counseling for mental health.
  
• Services for drug and alcohol abuse.
  
• Obstetrical-gynecological care and family planning services.
  
• Ongoing care for chronic (long-term) diseases, conditions, or disabilities.
  
• Physical therapy and other rehabilitative care.
  
• Home health, nursing home, and hospice care.
  
• Chiropractic or alternative health care, such as acupuncture.
  
• Experimental treatments.

Some plans offer members health education and preventive care, but services differ. Ask questions such as:

• What preventive care is offered, such as shots for children?
  
• What health screenings are given, such as breast exams and Pap smears for women?
  
• Does the plan help people who want to quit smoking?

What is Most Important to Me in an Individual Texas Health Insurance Plan?

In choosing a plan, you have to decide what is most important to you. All plans have tradeoffs. Ask yourself these questions:

• How comprehensive do I want coverage of health care services to be?
  
• How do I feel about limits on my choice of doctors or hospitals?
  
• How convenient does my care need to be?
  
• How important is the cost of services?
  
• How much am I willing to spend on premiums and other health care costs?
  
• How do I feel about keeping receipts and filing claims?

You might also want to think about whether a plan’s services meet your needs. Call the plan for details about coverage if you have questions. Consider:

• Life changes you may be thinking about, such as starting a family or retiring.
  
• Chronic health conditions or disabilities that you have.
  
• If you will need elderly care.
  
• Care if you travel a lot, attend college, or spend time at two homes.

How Do I Compare Individual Texas Health Insurance Plans?

After you review what benefits are available and decide what is important to you, you can compare plans. Many things should be considered. These include services offered, choice of providers, location and costs. The quality of care is also a factor to consider.

Custom Health Plans is your #1 source if you are looking for an affordable Texas health insurance company. Contact us today at (877) 749-2241 to learn how Custom Health Plans can also help with your Texas family health insurance, or compare quotes from all major carriers online.

Based in Plano, Texas we offer our services across the DFW metroplex and the entire state of Texas. So if you are looking for health insurance in Arlington, health insurance in Allen, TX, or health insurance in McKinney, you've come to the right place.