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The 2019 Definitive Guide To Texas Health Insurance for Individuals and Families

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Reading Time: 12 minutes

Table of Contents

Navigating the special enrollment period maze

How to Find the Best Texas Health Insurance Plans!

If you’re uninsured, you’re not alone. Millions of Americans are without health insurance, whether they lost it when they lost their job, are self-employed and must cover their own benefits or simply haven’t found the right plan yet. Finding and choosing the best Texas health insurance plans can be difficult if you don’t know where to start.

Since Texas health insurance rates are regulated by the state government, those interested in purchasing the best health insurance in Texas should focus on more than just price. Pay close attention to the following items when choosing a Texas health insurance plan to ensure you’re getting the plan that best suits your needs.

Covered services – What medical services are covered? Depending on your health and health care needs, look for policies regarding annual checkups, immunizations, maternity benefits and whether vision and dental insurance are included or covered under a separate policy. Another important consideration is whether specialist services are covered, including chiropractic care, acupuncture and physical therapy.

Deductible – A deductible refers to the amount an individual must pay for health care expenses before insurance starts to help cover the costs. Those requiring frequent doctor visits and prescriptions might benefit from a plan with a small deductible; other individuals might opt to pay out-of-pocket for their infrequent doctor visits and instead pair a Texas Health Savings Account with a high-deductible health plan to cover them in case of emergencies or catastrophic events.

Co-payments – Co-payments are predetermined flat fees that one pays for health care services, in addition to what their insurance covers. Co-payments often kick in once a deductible is reached, and different costs may be applied when seeing a primary care physician versus a specialist, and when filling prescriptions.

Co-insurance – Similar to a co-payment, co-insurance refers to money that an individual is required to pay for services. But rather than a flat fee co-payment, co-insurance is a percentage that an individual must pay toward a particular service. For example, an individual could pay 20 percent of prescription costs, while the insurance company picks up the remaining 80 percent. Depending on your needs and the amount you’re required to pay
for services, calculate whether co-insurance or a co-payment is the best option for you.

Network of providers – Is your doctor covered under your insurance policy? If not, you may have to pay more to see your ―out-of-network physician. If you ‖ have a favorite doctor, or see a particular doctor regularly, make sure he or she is covered by your insurance. Contact prospective insurance providers for a list of covered doctors, or simply ask your doctor if he accepts your insurance.

Pre-existing conditions – With the passing of the Affordable Care Act (also known as Obamacare), insurance carriers can no longer deny you coverage based on pre-existing conditions. It is still a good idea, however, to determine if any pre-existing condition you may have will impact your insurance premiums, or affect the doctors within your network.

Contact Custom Health Plans to speak with a licensed Texas Health Insurance broker today.

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