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

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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.

What is the difference between in-network and out-of-network?

When a physician is in-network, it means that they accept your specific health insurance plan. When they are out of network, they do not accept your plan. Whether or not your particular plan will cover out-of-network physicians depends on the plan type.

Determine if prescription medications are covered.

While prescription coverage may not always be considered a part of your plan, it is essential to find out. In this event, you may need to purchase a separate prescription plan to ensure that you can seek coverage for your medications when needed. All ACA plans must currently have some form of prescription coverage as mandated by the 10 essential health benefits.

How to buy individual health insurance in 2021?

Buying medical coverage has never been easier. Our fully licensed full-service texas health insurance brokerage will help you secure a short-term plan or an ACA marketplace plan at no additional cost to you.

Consider Short Term Health Insurance in Texas.

Whether your immediate need for individual health insurance is to cover a temporary or long-term gap in coverage, short-term health plan options are a great choice. If you are looking for a new job or in a waiting period before coverage kicks in, or if you just want minimal coverage at a great price, our team of experienced brokers can help you with all your health insurance needs.

Are you looking for Texas Health Insurance Plans for Individuals? Let us help.

We are a licensed and federally- facilitated marketplace brokerage that and can help you navigate your healthcare at no additional cost to you.

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