When comparing Texas health insurance plans, there are several questions you should consider before making a purchase.
Health insurance in Texas: the right questions to ask
What are the co-pays, deductibles and coinsurance requirements?
Does the plan require you to pay any or all of the following?
1. A co-pay is a specific, predetermined fee you pay when visiting a health care provider or obtaining a prescription. The co-pay can vary depending on which type of health care provider is visited (e.g. a general practitioner, a specialist or a hospital).
2. A deductible is the amount you will have to pay annually before the Texas health insurance carrier will pay claims outside of the routine or preventative care provided.
3. Coinsurance is the percentage of your medical costs you will pay after you reach any deductibles that apply.
How much freedom do you have to choose your own health-care providers?
Most Texas health insurance carriers have an approved network of health care providers in an accessible database online. If you have a specific health care provider that you want to use, simply check with the prospective health insurance carrier to make sure the provider is covered under your plan.
What type of plan is it? (HMO, PPO, EPO, POS)
Different types of health insurance plans exist:
HMO (Health Maintenance Organization): HMO plans require you to choose a PCP to coordinate all your healthcare services. Your PCP must recommend a specialist. HMOs limit your doctor and facility choices but lower costs by only covering in-network services.
PPO (Preferred Provider Organization): PPO plans allow more healthcare provider choice. You can see in-network and out-of-network providers without a referral. In-network providers reduce out-of-pocket costs. Specialists are easier to see without a referral.
EPO (Exclusive Provider Organization): Like HMOs, EPO plans only cover services from in-network providers, but they don’t require a primary care physician or referrals to see specialists. This balances cost and specialist access.
POS plans combine HMO and PPO features. You’ll need a primary care doctor and specialist referrals. POS plans allow out-of-network providers, but your out-of-pocket costs will be higher.
What is the annual deductible?
Before your insurance covers healthcare costs, you must pay the annual deductible. If you have a $1,000 deductible, you must spend $1,000 on healthcare before your insurance kicks in.
When choosing an insurance policy, consider deductibles, which can vary widely. A higher deductible plan will have lower monthly premiums than a lower deductible plan. To choose a deductible, consider your expected healthcare needs and finances. Check the plan details because some plans have separate deductibles for prescription drugs or out-of-network care.
Does the plan cover the health services that you need?
Depending on your health care needs, coverage for prescription drugs, preventative medicine, mental health benefits, maternity care, vision and dental care and specialty coverage like physical therapy or chiropractic care should be considered when deciding on the best plan for you and your family.
Does the plan cover health care providers outside your state?
If you often travel outside the state, inquire about Texas health insurance carriers’ policies on out-of-network coverage. Many plans will charge more for seeing an out-of-network doctor, but just having the option in place can allow you to travel knowing that you’re covered should you require any health services.
Does the plan offer individual AND family coverage?
Most Texas health insurance carriers offer coverage to all members of your family, but it is important to identify those that do not. Also, if you are still growing your family, make sure that maternity care is covered, or that a Texas health savings account is added to a high deductible insurance plan to aid in the extra costs of maternity care, should a pregnancy occur.
By answering the above questions, you can confidently begin to identify the best Texas health insurance plan for you and your family, all while staying within your budget.