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10 Things you Need to Know About Individual Health Insurance Plans in Texas

individual health insurance plans in texas

Table of Contents

Your Guide to Navigating Individual Health Insurance in Texas

With medical debt being the leading cause of consumer-related financial issues, it becomes a given that everyone should have some form of health insurance. When purchasing individual health insurance plans in Texas, most Americans have many options to consider. From deductibles to premiums and everything in between, we have compiled a list of 10 things you need to consider before deciding to purchase a health insurance plan.

When can you buy an individual health plan in 2021?

Buying a health insurance plan in 2021 is different than in years past. Thanks to the Biden administration, a special enrollment period (SEP) running from February 15th through May 15th, 2021 allows Americans to enroll in Marketplace plans during this limited time without a qualifying event. Another option is to purchase a short-term health insurance plan in Texas, which can be purchased at any time of the year and for varying lengths of time. Our full-service brokerage can help you with both of these options.

What do they cover?

All ACA health plans must cover 10 essential health benefits:

  • Outpatient care that includes chronic disease management
  • Emergency visits
  • Hospitalization
  • Pregnancy and newborn care
  • Mental health and substance abuse counseling sessions
  • Prescription Medications
  • Rehabilitation services and related devices
  • Lab blood results and tests
  • Preventive and wellness services
  • Dental and vision care for children

As an alternative, short-term health plans are not required to cover all of the benefits listed above and may have lower premiums. These plans are a great option if you are relatively healthy but want coverage for unexpected medical events.

Consider your deductible carefully.

It’s essential to consider your deductible when purchasing a health plan. While higher deductibles reduce your monthly premium, they may not be a good option if you do not always have extra cash on hand.

Know your health insurance premium options.

When selecting the right Texas health insurance plan, your monthly premium plays a significant role in your final decision. Depending on your income level, many ACA plans may cost more because you are paying for coverage you may not necessarily need based on your higher salary. In this case, a short-term plan could be a better option.

Know your copay and coinsurance levels.

It’s not uncommon for plan members to forget about costs outside of their plan deductibles, such as copays and coinsurance. These additional costs can add up quickly, so it is essential to know these amounts upfront so there are no surprises down the line when a medical claim is presented.

What are the different plan types?

There are three most common health insurance plan types, and each one has different benefits. They are:

  • HMO – Health Maintenance Organization, referrals for specialists, are needed and will only cover in-network care.
  • EPO – Exclusive Provider Organization, no referral required, will only pay for in-network care.
  • PPO – Preferred Provider Organization, doesn’t require referrals to see specialists and allows you to seek out of network care.

Understanding the Difference Between In-Network and Out-of-Network Providers

In-network physicians are healthcare providers who have agreed to accept your specific health insurance plan, providing services at negotiated rates. Conversely, out-of-network physicians do not have contracts with your insurance plan, which may result in higher costs for you. Your insurance plan may or may not cover out-of-network providers, so it’s crucial to understand the details of your coverage.

Assessing Prescription Medication Coverage

Prescription medication coverage is a crucial aspect of health insurance. It may be included in your health plan, or you might need to purchase a separate prescription plan. All plans under the Affordable Care Act (ACA) are required to offer some level of prescription coverage as part of the 10 essential health benefits.

Purchasing Individual Health Insurance in 2023

Acquiring health insurance has become more straightforward than ever. Our fully licensed, full-service Texas health insurance brokerage can assist you in obtaining either a short-term plan or an ACA marketplace plan at no extra cost to you. Our team will guide you through the process and help you find the right coverage.

Exploring Short-Term Health Insurance Options in Texas

Short-term health insurance plans can be an excellent solution for those seeking coverage during temporary or long-term gaps in coverage. Whether you are between jobs, waiting for new coverage to begin, or simply want minimal coverage at an affordable price, our experienced brokers can help you find the right short-term health insurance plan to meet your needs.

Find the Right Texas Health Insurance Plans for Individuals with Our Assistance

As a licensed and federally-facilitated marketplace brokerage, we are equipped to help you navigate your healthcare options at no additional cost to you. Our team of experts is dedicated to finding the right individual health insurance plan to suit your specific needs and preferences. Let us help you secure the healthcare coverage you need today.

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