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The Ultimate Guide to Family Health Insurance Plans in Texas

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Around 89% of people in the United States have health insurance. If you don’t have insurance coverage or if you’re expanding your family, you may not know what the next steps are. Don’t worry, we are here to help. 

There are many benefits of having health insurance, but it can be challenging to know which plan is best for your family. If you get sick or if an unexpected accident happens, you don’t want to worry about how you’re going to pay for it. Your number one priority should be getting healthy and taking care of your children and spouse. 

In this article, we are going to tell you everything you need to know about family health insurance plans in Texas. Keep reading so you can know your options. 

What Is Health Insurance 

Health insurance helps cover a person’s medical expenses. It’s a contract between you and an insurer.

You’ll pay a premium and then the insurance company will pay for some, sometimes all, of your bills related to your health. This can include medications, check-ups, and surgeries. 

Who Is Family Insurance For

Family health insurance is for anyone with more than one person on their plan. For example, if you are married then you can purchase family insurance.

You’ll then be able to add any children you may have to your plan. You can purchase family health insurance if you’re a single parent with children.

Typically, children can only stay on your health insurance plan until they are 26. Then they will need to get their own.

Your child under 26 doesn’t have to live at your house or be enrolled in college to be on your plan. If your child is married, they can still remain on your plan; however, their spouse can’t be added. You can also keep a dependent grandchild on your family health insurance until they are 25 years old. 

You may be wondering if you can add an elderly parent to your plan. Unfortunately, no, your parent will need to purchase individual health insurance.

Cost

When you’re choosing between family health insurance plans in Texas, you’ll need to consider the cost. Different plans vary in cost; take your time comparing insurance coverage so you get the one that fits your family’s needs the best. 

Health issues and medical bills can be devastating and cause many people to go into debt. Having health insurance can relieve stress and pressure.

You’ll have peace of mind knowing you and your family will be taken care of if something unexpected happens. However, there are a few fees and costs that you need to know about. When you’re searching for a health insurance plan, these are the prices, you’ll want to compare. 

Premium

The premium is the monthly amount you pay each month for your plan. Many employers may offer to cover part of your premium as well, so be sure to check with them first. 

Copay

Every time you visit the doctor, receive health services or have a procedure, you’ll have to pay a copay. This is typically between $20 and $100. The majority of the time this is a flat fee; however, it could be more for certain services. 

Deductible

The deductible is the amount of money you have to pay before your insurance starts to cover the cost. This price can vary and you’ll typically get to pick how large or small you want the amount to be.

If you want a lower deductible, you’ll pay a higher monthly premium. If you want a lower premium, you’ll have a higher deductible.

For example, if your deductible is $2,000. You’ll cover the first $2,000 of your medical bills, then your insurance company will start to help. 

Coinsurance

You’ll still be responsible for part of your bill. This is coinsurance and it’s typically determined by percentage. 

Let’s say you have $10,000 worth of medical bills and your insurance plans cover 80% and you have to cover 20%. If you haven’t paid your deductible then you’ll have to pay that first. 

So you’ll pay $1,500 and then the bill will be $8,500. Your insurance company will cover 80% of the bill, which will be $6,800, and you’ll pay $1,700. 

At the end of the day, you’ll pay $3,200 of your $10,000 medical bill. Later on in the year, if you have another service or surgery, you won’t have to pay the deductible. You’ll only be responsible for 20%. 

Out-of-pocket maximum

There is a maximum amount you can pay a year. This can help protect you if you or your family have a lot of treatments or medical services. Once you pay the maximum amount insurance will cover 100% of the costs. 

Types of Insurance Plans 

In Texas, there are a few insurance plans you can choose from. You have the option to customize your plan so you get all the coverage you need. 

HMO 

The Health Maintenance Organization plan has some great benefits, but there are also a few downsides that you need to be aware of. With this plan, you are limited to the number of providers you can see.

Your primary doctor will coordinate with other providers that work within the organization. You’ll need a referral from your doctor if you want the service to be covered.

There is an expectation for emergencies. The great thing about this option is that it has fewer out-of-pocket fees and costs. 

PPO

Preferred Provider Organization (PPO) is a health insurance plan that doesn’t require you to use doctors within their network. You can go to hospitals and specialists, without a referral; however, you will pay more.

If you like to have options when it comes to your doctors, hospitals, and specialists, this could be a great option for your family. Keep in mind there are higher out-of-pocket costs with this plan. 

HSA

Another plan is a health savings account (HSA). This plan allows you as an employee or freelancer to put money into a savings account for medical expenses pre-taxed. You’ll be able to lower the amount you pay for services.

However, you can’t use the money you put into the account for your premiums. It can be used for copays, coinsurance, and deductibles though. 

Dental and Vision

The majority of health insurance plans don’t cover vision and dental services. However, it’s crucial that you confirm this before you purchase an insurance plan. 

Health Insurance Options 

There are a few options you can choose from when it comes to health insurance plans. These plans determine the prices and percentages of the factors we discussed previously. 

Bronze is the most affordable insurance policy. However, that means you’ll be paying a lot out-of-pocket.

You will have a low monthly premium, but your deductible will be high and so will your coinsurance. The bronze plan will be over 60% and you and your family will need to cover the rest. 

There is a silver, gold, and platinum plan too. Each one goes up in premium costs but is lower in copays and other fees. If you purchase a platinum plan, 90% of your medical bills will be paid for by the insurance company. 

Take your time deciding which plan is best. If your family is healthy then you may not need the platinum plan. However, you’ll always need to keep in mind that unexpected events happen all the time and it’s better to be prepared.

Higher Premiums 

It can be hard to know when to purchase a plan with a high premium vs a lower one. Here are a few things to consider that will help you decide. If you answer yes to any of the questions below, a higher premium with a lower out-of-pocket fee may be the best option for you. 

  • Are you pregnant or plan to have a baby soon
  • Do you visit the doctor or a specialist often 
  • Do you or someone in your family take brand-name prescriptions frequently
  • Do you have a chronic disease or medical condition 
  • Is there a planned surgery in the future 

Things To Know

If you or someone in your family has a preexisting condition, an insurance company can’t deny you. The same goes if you or your child has a disability. The more people you add to your plan, the more expensive it’ll be; however, it’ll be cheaper per person than if you bought individual insurance for each person. 

If you have a preferred doctor, you’ll want to be sure to ask if they accept that insurance before you purchase it or switch. If you don’t have a specific doctor you want to go to, then you don’t have to worry about that as much.

Saying that, a more extensive network or company will likely be accepted at more medical facilities. That means you’ll have more options when it comes to providers. You won’t want to be stuck with a doctor you don’t like because he or she is the only provider in the area that accepts your insurance. 

Questions to Ask

Don’t hesitate to ask your agent questions. They will understand this is a big decision for you and they shouldn’t rush or pressure you. Below are a few questions that you should ask your insurance agent before purchasing a plan. 

Are My Family’s Prescriptions Covered Under This Plan?

You don’t want to switch or purchase new insurance only to find out later that your child’s medications aren’t covered. Show your family’s list of regular prescriptions to the agent so they can confirm if they will be covered. Medications can be hundreds of dollars monthly and you may not be able to afford that. 

Will I Have Easy Access to Health Care?

If you or your partner gets sick, you don’t want to have a hard time finding someone to treat you. If you’re required to see a certain physician, you’ll want to know that ahead of time.

You should also find out if virtual appointments are covered by the plan. Children tend to get sick often, especially when they start going to school; consider if there are clinics in your area that you can go to. 

Are Alternative Health Services Covered?

There are times when you or your child may need some type of therapy, whether it be talk, group, or physical therapy. If you’re planning on having a home birth or need regular chiropractor appointments, they might not be covered under your regular family insurance plan. 

Are There Perks That Come With This Plan?

Some insurances will come with extra benefits such as gym memberships, online appointments, and maybe even discounts at grocery stores. This shouldn’t be a deal breaker if they don’t have extra benefits, but it never hurts to ask. 

Does the Plan Cover Me if I’m Abroad?

If you love to travel or plan on vacationing aboard with your family, you need to know if you’re covered. They should have resources for you to use in case you get sick overseas. 

Family Health Insurance Plans in Texas

Health insurance is an investment, but it’s crucial to have it so you always know that your family is safe. Medication, procedures, and illnesses can happen at any time and you need to be prepared.

There are many family health insurance plans in Texas that you can pick from. The right plan for you shouldn’t break the bank, but it should give you all the coverage you need. 

If you’re wondering which one is best for your family, contact us here. We have helped hundreds of families feel protected and covered. We have a great team available that can help you get set up and answer any questions you may have.

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