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7 FAQs about Austin Health Insurance Answered

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Did you know that 55% of Americans are confused by their health insurance? If this includes you, then it could be costing you money in unnecessary fees or payments. Or, even worse, it might mean you’re not getting or using the full benefits of your plan.

Don’t worry if you find that you have any questions regarding your health insurance options because you’re in the right place. We’ve rounded up the top most frequently asked questions that we hear every day and created this resource just for you.

So keep reading to get all the information you need to choose the best Austin health insurance plan for you and your situation and budget.

FAQ #1: Is Insurance Required in Austin, Texas?

As of 2019, there is no longer a federal mandate for individual health insurance in the United States. Some states, such as Massachusetts and New Jersey, chose to create a state mandate. Their penalties for not carrying individual health insurance vary based on income and family size. Other states, such as California and Rhode Island, along with the District of Columbia, have instituted mandates with penalties regardless of income level.

In Texas, you’re not required to carry individual health insurance plans to cover your or your family. However, health insurance helps protect you against unforeseen and expensive treatment.

Too many families run into financial ruin due to unexpected healthcare costs. Protect your family by finding an insurance plan to safeguard your financial future.

There are several affordable health insurance plans that will protect you from unexpected and financially burdensome healthcare costs. An experienced agent can help you find the right coverage to protect you and fit your budget.

FAQ #2: Can My Application Be Denied?

Historically, many insurance companies deny care for any condition they deem “pre-existing.” Thanks to the Affordable Care Act, you can’t be denied health insurance due to a pre-existing health condition. In addition, crucial preventative care and maternity care are included in most insurance plans.

However, depending on your situation or time of the year, you might need to wait to enroll until the open enrollment period. Many individuals also qualify to enroll during a particular enrollment period. These periods usually follow a significant life change such as marriage or pregnancy.

Today’s healthcare insurance applications no longer include lengthy personal medical history questionnaires or examinations. Now, you simply enter your contact information, demographics, and income history. The marketplace then uses this information to determine how much you qualify for in subsidies and tax credits.

Once you have health insurance, you might run into another tricky denial situation. This usually involves specific care or treatments prescribed by your doctor getting denied.

If that happens, be sure to call the customer service number for your insurance plan. Many times the reason for this is that your doctor’s office may have inadvertently used a wrong diagnosis code or forgot to include it in their reimbursement claim.

Don’t pay any unexpected bills outside your premium or copays up to your deductible. For many of us, calling an insurance company can be unnerving.

However, they want to work with you. So, take the time to call; it could save you hundreds or thousands of dollars.

Often it is easier and less expensive for them to simply deny a claim rather than call the doctor’s office themselves to correct any mistake. Unfortunately, that means it’s your job to advocate for yourself and ensure that your insurance company pays for anything your doctor has deemed necessary.

FAQ #3: Can I Be Terminated if I Get Sick?

Another benefit from the ACA is that your insurance company can’t cancel your plan. This includes losing your health insurance coverage due to getting sick.

There are only three reasons your health insurance company can terminate your plan. These three reasons are:

  1. You don’t pay your insurance premiums on time
  2. You voluntarily quit your coverage
  3. Death of the individual subscriber

Outside of these three reasons, you can rest assured that your healthcare coverage plan will protect you and your family in case of severe injury or illness.

FAQ #4: Are My Routine Preventative Exams and Visits Covered?

Preventative healthcare can catch and often cure expensive medical problems. For too many years, uninsured and underinsured individuals often waited until healthcare problems became an emergency before seeking treatment.

Luckily that changed with the passing of the ACA. The Affordable Care Act states that insurance companies must not only cover all preventative healthcare costs but also cover them entirely. This means you won’t have a copay for routine examinations, cancer screenings, or immunizations and testing, including COVID-19 vaccination and booster shots.

Many routine appointments are covered under these statutes, so take advantage of and utilize your health insurance coverage to the fullest. Overall, healthcare costs can be decreased or eliminated by routine healthcare visits. This is why it makes the most sense for insurance companies to cover these visits and for you to use all the benefits afforded to you by the ACA.

FAQ #5: Is My Doctor Covered Under My Plan?

Many insurance companies contract with certain doctors and healthcare facilities. This is why it’s so vital for you to do your homework before choosing the best insurance plan for you and your family.

You have two options for ensuring your doctor visit is covered under your insurance plan. First, you can ask your preferred provider which insurance companies they contract with. Then when you choose your insurance plan, you’ll want to select from the list of companies your doctor accepts.

The second situation is if you don’t already have a doctor you love. In this case, you can choose your insurance company based on what treatments they cover or their overall costs. Then look through the list of doctors they cover and select your primary provider from that list.

Taking the time to do one of these two options will save you hundreds of dollars down the road. You don’t want to make the mistake of choosing to see a doctor that isn’t approved by your insurance company. The out-of-network costs can become prohibitive if you accidentally visit a doctor that isn’t accepted by your insurance company.

FAQ #6: Will I Need a Referral?

Certain healthcare plans require you to seek pre-approval from them before receiving treatment from specialty providers. It’s your responsibility to get this pre-approval before getting treatment, or you risk ending up with a hefty bill.

Due to these referral policies, many people have had to choose to pay out of pocket to get the care they need. And unfortunately, many more have chosen not to receive the care they need due to being unable to get pre-approval.

Most Health Maintenance Organizations (HMOs) and point of service (POS) plans require receiving a referral before you seek specialty treatment. Many Preferred Provider Organizations (PPOs) don’t need referrals. However, they tend to be more expensive and exclusive than HMOs or POS plans.

FAQ #7: When Is Open Enrollment?

Most health insurance companies only allow you to sign up for one of their plans during a specific window. For example, if you start a new job, you likely have 30 days to sign up for health insurance. Conversely, if you leave a job, you have a certain number of days to sign up for their COBRA plan.

When it comes to the healthcare marketplace or Medicare, there are specific dates during which you can sign up for a new plan or update your existing plan. Unfortunately, there are many risks associated with missing an open enrollment period. These could include paying a penalty, missing a tax credit, or even missing out on getting health care coverage altogether.

There are also certain life events that will make you eligible for updating or applying for healthcare insurance coverage. For example, if your income goes below a certain percentage of the federal poverty level, you could qualify for Medicaid or CHIPs. We’ll cover more about other life events in the Special Enrollment period section below.

As mentioned, there are several different dates you need to pay attention to each year, depending on what type of insurance you need. We’ll break down each of the open enrollment windows so you can ensure you get the right plan for you and your family.


At the end of the year, the federal health exchange marketplace opens for enrollment. During this window, anyone can choose a new healthcare plan or upgrade their current plan for the following year.

The dates for ACA open enrollment are November 1st to January 15th in the state of Texas.

Some states have their own exchange marketplace and follow a different calendar. However, in Texas, we use the federal exchange and its open enrollment dates. If you experience a significant life event, you might qualify for a special enrollment period which we’ll cover below.

In addition, thanks to the Inflation Reduction Act, there are now new savings you can see on your premiums through the year 2025. You might also be eligible for higher tax credits thanks to this ground-breaking act passed by Congress. The federal healthcare website has a calculator you can use to see if your income and family size qualify you for increased tax credits.


Every year, at the end of the year, Medicare has an open enrollment period. During this period, you can update your insurance options, switch to an Advantage plan, or add a supplement plan for the following year.

The dates for Medicare open enrollment are October 15th to December 7th.

During this time, you can change your coverage to include a new provider or prescription that you want or need to be covered. You can weigh your options and decide if you want to stay with the commercial, federal Medicare plan or use an Advantage plan. You can also check or change your Medicare parts B, C, and D coverage to ensure that all your needs are met with as few out-of-pocket expenses as possible.

Special Enrollment Period

There are several different reasons that you might need to change your health insurance policy. The open exchange market allows for exceptions if you experience any of the following events:

  • Loss or change of job resulting in loss of insurance
  • Moving to a new address
  • A significant life event such as marriage, divorce, death, pregnancy, or having a baby (including birth or adoption)

If you’ve recently experienced any of these qualifying events, you must reach out to an experienced agent. Each event has a specific window within which you can change, upgrade, or sign up for new health insurance. So, don’t wait too long before reaching out, so you don’t miss your opportunity to improve your health insurance options.

Choose the Best Austin Health Insurance Plan For Your Family Today

As you can see, choosing the best health insurance plan can feel daunting at best. That’s why we’ve put together this list of our most frequently asked questions.

However, this list isn’t exhaustive. If you still have questions about which Austin health insurance plan is right for you, you need to talk with an expert.

Here at Custom Health Plans, we’ve been helping our Texas neighbors with quality advice at no cost to you. Our team of professionals has over 30 years of combined experience, and we aren’t happy until you have the right plan at the best price for your family. If you’re ready to see how you can protect your family from unexpected medical costs, get your free quote today.

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