Texas has the lowest health insurance enrollment rate in the nation. In 2021, 18% of Texans did not have a health insurance plan. The runner-up was Oklahoma, with 14% of residents uninsured.
Are you a Texan who does not have health insurance coverage? If so, it may be because you think you can not find cheap health insurance in Dallas. But it is time to think again.
At Custom Health Plans, we specialize in creating low-cost health insurance policies to suit your budget and unique needs. So, we feel especially qualified to teach you how to find cheap insurance options.
If you have been putting off health insurance because it is too expensive, keep reading this guide to learn how to cut costs. And stick around to learn more about our health insurance solutions for Texans.
Types of Health Insurance Plans in Texas
Texas health insurance costs vary widely based on a number of factors. One of those factors is the type of plan you need, including how many people you need to cover under the policy.
Below, we will discuss the three most common types of health insurance plans in the Lone Star State: individual insurance, family insurance, and short-term insurance plans for individuals and/or families.
Individual and Family Insurance Plans
Individual health insurance plans cover single people. Family insurance plans, as their name suggests, cover families of all sizes.
Early retirees, self-employed people, and people employed by small businesses that do not offer health insurance benefits may need individual insurance.
But trying to get an individual health plan for each member of your family is not cost-effective. Instead, private companies offer family health insurance plans to reduce the total cost of insurance for your household.
Short-Term Insurance Plans
Each year, the federal government and health insurance providers host open enrollment from November 1st to January 15th. This is typically the only time you can enroll in health insurance, barring a qualifying event.
If you miss open enrollment, you will not have health insurance coverage until the next enrollment period. However, you can supplement your insurance needs with a short-term health insurance policy.
Short-term insurance offers coverage for 12 months (or until the next open enrollment period), plus the option to renew. It works well for people without insurance and those who are switching jobs.
The benefit of short-term insurance is that it costs significantly less than traditional health insurance policies.
If your current health insurance plan has become a cost burden, you can switch to short-term insurance until you get back on your feet.
Private vs. Federal Health Insurance: Which Is Cheaper?
Government-sponsored health plans will always be cheaper than private insurance. That is because the government designed programs like Medicare and Medicaid for low-income people.
If you qualify for federal health insurance, you should absolutely apply for a policy during open enrollment. It is the best way to save money on health insurance in Texas.
However, most people do not meet the qualifications for Medicare and Medicaid. For example, you must be over the age of 65 to qualify for Medicare.
Medicaid is available to individuals and families of all ages. But you or your family must qualify as low or very low income.
Individuals can not make more than $26,909 (pre-tax), couples can not bring in a combined income of over $36,254, and families of 3–8 people must earn less than $45,600–$92,328.
Learn more about income requirements for Medicare at this link.
In addition to the income requirement, you are only eligible for Medicaid if you meet the following criteria:
- You are pregnant (individuals)
- You are responsible for a child who is 18 years of age or younger
- You or someone are blind (individuals)
- You or someone in your household has a disability
- You are 65 years of age or older (individuals)
Luckily, if you do not qualify for federal insurance, you can still get a private insurance plan. Next, we will give you some tips to find the lowest-cost private insurance available.
How Private Insurance Companies Help Make Healthcare More Affordable
Due to the Affordable Care Act (ACA), all US health insurance providers must offer four different tiers. These tiers vary in terms of costs and include:
- Bronze plans
- Silver plans
- Gold plans
- Platinum plans
Each plan differs in how it deals with various out-of-pocket costs that policyholders must pay. In general, Bronze plans cost less, while Platinum plans cost more. But the exact areas where these costs come in differ.
Premiums are the monthly fee you pay for health insurance coverage. Bronze plans have the lowest monthly premiums, while Platinum plans have the highest monthly premiums. Silver and Gold premiums fall in the middle.
Choosing a lower premium is a great option if you have little cash flow or live paycheck-to-paycheck. But if you can afford slightly higher premiums, there are some significant benefits to the other packages.
A deductible is an annual spending limit that policyholders must reach before the insurance company covers any of the cost of care. Your deductible renews annually.
Platinum health insurance policies have the lowest deductibles. That means your insurance company will start chipping in for care much earlier than with other plans.
Bronze plans have the highest deductibles. That means you will pay a lot more out-of-pocket per visit.
As you can see, monthly premiums and deductibles have an inverse relationship. You must have a high deductible if you want a low monthly premium. But you must have a high premium if you want a low deductible.
Copays and Coinsurance
Copays are fees you must pay each time you visit a healthcare provider, whether in person or online. Coinsurance is the percentage of healthcare costs you must cover once you meet your deductible.
Health insurance providers typically offer either copays or coinsurance. Choosing a copay can be the better option because you will know exactly what you will pay out-of-pocket for each visit. But coinsurance can be better for reaching your deductible faster.
Regardless of which one you choose, Platinum copays and coinsurances tend to be lower than Bronze ones. Silver and Gold plans fall somewhere in the middle.
The out-of-pocket maximum refers to the cap on out-of-pocket costs you can incur before your insurance company covers some of your costs. The out-of-pocket maximum restarts each year.
That may sound a lot like a deductible, but there is a difference. Once you meet your deductible, your insurance company will only pay for a percentage of care. That usually breaks down as the following:
- Bronze: insurance covers 60% of costs once you meet your deductible
- Silver: insurance covers 70% of costs once you meet your deductible
- Gold: insurance covers 80% of costs once you meet your deductible
- Platinum: insurance covers 90% of costs once you meet your deductible
But if you meet your out-of-pocket maximum, your insurance provider must cover 100% of your health insurance costs for the rest of the year.
As you can imagine, deductibles are typically much lower than out-of-pocket maximums.
Choosing a plan with a relatively low out-of-pocket max will cost more. But it is a good idea if you are expecting significant medical costs in the coming year.
How Health Insurance Networks Impact Costs
No matter which policy level you choose (Bronze, Silver, Gold, or Platinum), you can get access to the various types of insurance networks. These plan types include EPOs, HMOs, POSs, and PPOs.
Keep reading to learn more about each of these networks and which ones offer the most savings.
“EPO” stands for Exclusive Provider Organization. This type of plan requires you to use in-network providers to receive insurance coverage. If you use an out-of-network provider, you have to pay 100% of the cost of care.
This type of insurance network provides the least flexibility and, therefore, the most savings. EPOs are the most affordable choice if you exclusively receive your care in your area and don’t tend to travel.
“HMO” stands for Health Maintenance Organization. This type of plan also limits your use of providers to those who are in-network. However, HMO insurers may provide limited coverage for emergency out-of-network care.
An HMO plan tends to cost more than EPO but less than POS and PPO policies. However, it does offer more flexibility than an EPO.
This may be the lowest-cost option for you if you primarily receive care in your area but want room for emergencies while you are traveling.
“POS” stands for Point of Service. POSs offer significant savings when you use an in-network healthcare provider. But you can still receive limited coverage for out-of-network care.
POSs can be quite expensive in terms of monthly premiums. The only reason this type of network may be more affordable for you is if you receive a significant amount of care from outside of your network.
Still, if that is the case for you, you may benefit further from a PPO if you have money to spare for the higher monthly premium.
“PPO” stands for Preferred Provider Organization. Like POSs, PPOs can help you save on in-network health care. You will still receive coverage for out-of-network care but at a higher cost.
The difference between a POS and PPO is that the former requires you to get a referral to see a specialist. With a PPO, you can see the specialists you want without having to get a referral from your primary care provider.
As you can see, PPOs offer a lot of flexibility for policyholders. But you have to pay for that convenience. PPOs tend to have the highest monthly premiums of any of these network plans.
Who Offers Private Health Insurance in Texas?
There are 15 private health insurance companies that offer their services in Texas, including:
- Aetna CVS Health
- Blue Cross Blue Shield of Texas
- Scott & White Health Plan
- UnitedHealthcare of Texas
- Ascension Personalized Care
- Imperial Insurance Companies
- Moda Health Plan
- Community Health Choice
Cigna, Ascension, and Imperial are new to the Texas health insurance marketplace in 2023. And Aetna CVS recently expanded its coverage area in Texas.
Other Factors to Consider When Shopping for Affordable Health Insurance
We have already discussed how the type of plan and network can impact your overall costs. Make sure to use these factors to add up the total cost of insurance, including your premium, copays, etc.
But what other factors should go into your final decision?
First of all, make sure to consider your health care needs. Do you go to the doctor a lot or not at all?
If you are young and in good health, a low-premium plan may be cheaper for you. But people with significant health care needs should consider a higher-premium policy with a lower deductible to see more savings.
Secondly, consider your provider needs. Do you intend to continue seeing your primary care provider? If so, make sure he or she is in-network with the plan you choose.
If your plan does not cover visits with your preferred provider, you may find the higher monthly premiums worth it to get more flexibility.
Need Help Choosing Cheap Health Insurance in Dallas?
Health insurance affordability varies widely based on your income level, health care consumption, and more. Even with the help of this guide, it can be tricky to figure out exactly what kind of policy you need to produce the most savings.
That is where Custom Health Plans come in.
We are a Texas health insurance broker and your #1 source for cheap health insurance in Dallas. Get a free health insurance quote from us today, or get in touch to learn how we can help you customize the perfect plan.