Texas Health Insurance Frequently Asked Questions

You should gather at least five quotes from different companies to make sure that you are getting the best price. You just want to take a little extra time and do some due diligence to make sure that you are getting the best plan. The cheapest plan is not always the best plan. What is important is finding the right balance between coverage and cost and this cannot be done by looking at just one quote. Plus, getting extra quotes ensures you are not getting scammed or ripped-off by one company.

A Defined-Contribution Health Plan is not the same as Group Health Insurance for small businesses. In a defined-contribution health plan (a.k.a. health reimbursement account), your company makes a fixed contribution towards the plan, which employees can then use to pay for health care expenses. In a typical group health plan, employers absorb the majority of the cost of premiums; defined-contribution health plans are a way to share the cost of health insurance.

HSAs allow participants to decide how much money, up to IRS limits, to set aside for health care costs. The account holder decides how to spend the money and can shop around for care based on quality and cost. Depending on the plan design, an employer may contribute to the HSA account, but the money belongs to the employee. Any unused money each year can be rolled over (stays in your account) to the next year. The account contributions, and any interest or investment it earns, are tax-free.

Pressure to save money in a HSA might lead people to avoid seeking medical care when needed. In addition, people may have trouble finding good information about the cost and quality of medical care. People who are older or sicker may not be able to save as much as younger, healthier people. Lastly, money taken from an HSA for nonmedical expenses will be taxed and incur a penalty.

One way the ACA reforms health insurance is by mandating that all insurance policies offer a basic level of “essential health benefits” such as:

• Ambulance services
• Emergency room and hospital stays
• Newborn and maternity health care
• Substance-use disorder services
• Mental health services (plus behavioral health treatments)
• Prescriptions
• Preventative and rehabilitative healthcare services
• Wellness programs
• Laboratory services
• Pediatric health care (plus dental and vision coverage).

Health plans that do not meet these minimum requirements will subject you to the federal government’s tax penalty for not having “ACA-compliant” health insurance.

Certainly, the ACA has good intentions, but in reality, much confusion and conflicting information still surrounds the law. Knowledgeable insurance advisors understand ACA well. These frequently asked questions will lay the foundation for a constructive conversation. Contact us today to find a health insurance option that is right for you and your loved ones.

Generally speaking, many of the policies are designed to ensure your specific coverage needs are met until your long term health plan begins. We can help you find a Short Term Health Plan that will provide health insurance coverage until the next open enrollment period.

Similar to a 401(k), an HSA belongs to the account holder even after employment ends.

Health savings accounts are like personal or retirement savings accounts, but the money in them is set aside tax-free to pay for health care expenses. The HSA is owned and controlled by the account holder, not their employer or insurance company.

A Health Savings Account is like a regular savings account except that it allows you to save pre-tax income for health related purposes only. In order to qualify for a health savings account, you must already be covered under a high-deductible plan that will cover your medical costs if they are very expensive and you cannot pay them (ie. if you are involved in a traumatic accident and require a costly hospital stay. A high-deductible plan is used mainly for these type of catastrophic accidents as it does not cover the first few thousand dollars of medical expenses). A health savings account is beneficial as it allows the consumer to be in control of their own money and choose how to spend it, as opposed to letting the insurance company decide how to spend it.

Health Savings Accounts (HSAs) are the latest innovation in managed care plan designs. HSAs work like an indemnity plan with a point-of-service plan backend. The health plan includes preventive care, dental and vision as well as complete flexibility. Members can see any provider using the pre-tax money saved in their savings account. HSAs are a high-deductible point-of-service plan that kicks in once the member has spent above the deductible. These plans typically cost a lot less than regular POS plans, but the member needs to pay attention to their costs.

Medical Savings Accounts (e.g., the Archer MSA) are very similar to HSAs. They are both used with HDHPs. The big difference is that any employer can offer an HDHP and HSA combination to their employees, whereas the MSAs were developed for those who are self-employed and employers with up to 50 employees.

With Short Term Health insurance, you can get health insurance coverage for a short period of time, typically between 30 days and 11 months. Short Term Health Plans are designed to provide coverage for when you are in-between long term plans. They are an ideal solution for those who missed the Obamacare Open Enrollment period and are in need of health insurance. These plans can typically be started within 24 hours, providing great coverage at a fraction of the cost of a typical Obamacare ACA plan.

The subsidy reduces how much qualifying individuals must pay in health insurance premiums. To be eligible for a subsidy, your household income cannot exceed 400 percent of the federal poverty level. If you qualify and enroll in a subsidy-eligible health plan, the government pays its portion of your premium directly to the insurance company. The exact amount of your subsidy depends on where your income falls below the federal poverty level, and also on the cost of the benchmark health plan in your area.

If you wish to buy individual health insurance, you can get started with a quote using our quote engine below. Alternatively, you can contact us today to get expert advice about a plan that is right for you.

Individuals are attracted to Short Term Health Plans not just because of their flexibility, but also because of their affordability. Typically, Short Term Health Plans are half or two thirds the cost of an Obamacare ACA plan. This means that not only can you get Short Term Health Plans outside of Obamacare Open Enrollment periods, but you can actually find significant savings when doing so. Keep in mind the higher the deductible the lower the premium, and vice versa. This flexibility means that Short Term Health Plans can be very inexpensive and affordable.

We offer a variety of Short Term Health Plans from a variety of companies, and work to find you the best rates for your insurance needs. Short Term Health Plans typically cost significantly less than traditional Obamacare ACA plans, and can provide up to $1.5 million in coverage.

An individual health insurance plan is purchased by you, whereas a group health insurance plan is purchased by an organization for its members. Group health insurance plans may cost less for its members, but an individual health insurance plan empowers you to make sure your specific health care needs are being met by your insurance.

A Texas health insurance individual plan is purchased by you directly from the insurance company. Whereas, with a group health insurance plan, the group is insured and the insurance company contracts within the group. Insurance credentials, issued to a participating member, act as your policy. Often group health insurance costs less than if the insurance company sold individual policies to all members separately. In addition, group health insurance sometimes holds special coverage’s that are not obtainable (or are very costly) on an individual basis. The purchasing power of the group makes this reasonably feasible.

The purpose of the new health insurance marketplace is to expand access to affordable health insurance for the uninsured. However, your state may refer to this marketplace as a “health insurance exchange,” which may explain the confusion.

The ACA works by creating a federally regulated health insurance marketplace (i.e., health insurance exchanges) for single individuals, their families, and small businesses. The Small Business Health Options Plans (SHOP) marketplace is the ACA’s program that focuses on the health insurance needs of small businesses. However, many small-business owners incorrectly assume that they must buy group health insurance through the SHOP marketplace.

As a small business owner, you understand that the high cost of small group health insurance prohibits you from offering health coverage to your employees. The SHOP marketplace’s intent is to provide small-business employers with the chance to purchase federally subsidized, low-cost group health insurance. The caveat is that not every small business qualifies for tax credits to offset costs in the SHOP marketplace. This is part of the reason why many small business owners are seeking Defined-Contribution plans as an affordable health care solution for their organizations.

The Internal Revenue Code stipulates that the expenses must be to alleviate or prevent a physical or mental condition or illness, including dental and vision care (basically the things typically covered by health care plans). The money cannot be used for health club dues, illegal treatments, over-the-counter items (except insulin) or surgeries for cosmetic purposes.

• The doctors and hospitals in the provider network.
• The monthly premiums.
• The annual deductible, both individual and family.
• The copayment amounts for doctor visits, emergency room, etc.
• Any applicable coinsurance (percentage of cost you may pay for covered services).
• Annual maximum out-of-pocket limits.

There are a number of important factors you should consider before purchasing individual health insurance plans. Ask yourself the following questions to help you decide what type of plan makes sense based on your finances and needs:

1. Health Care Needs: The first consideration when selecting a health plan is determining what your specific needs are. How often do you go to the doctor? Will your needs change in the next year, such as starting a family? Are you receiving on-going treatment? Do family members need their own individual health plans to get the coverage they need?
2. Hospitals and Doctors: The second consideration is the network of doctors and hospitals in the plan. If you like your doctor, is he or she in the plan? Are the doctors and facilities conveniently located near you? Do you have freedom to see whomever you want?
3. Costs: The third consideration is the cost of your plan, and what benefits package makes sense based on your finances. Under the Affordable Care Act, many health insurance plans for individuals now have bronze, silver, gold and platinum benefit levels that indicate the level of coverage (and associated costs) the policyholder will have. When considering the options, be sure to see what each plan does or does not cover and what would be your out-of-pocket cost. Before making a decision, consider the various plans’ monthly premiums, deductibles, copays, coinsurance and other expenses. Are you eligible for a federal subsidy or tax credit to help pay for the health insurance?

There are a number of health insurance options to meet your specific health care needs. The following plan types should give you a better idea of what plan makes the most sense for you:

• Indemnity (Fee-for-Service, or FFS) Plans: These medical plans offer the greatest flexibility in choosing your doctors. The limitation with Indemnity plans exists in the amount of the reimbursement that an insured party can receive to cover medical expenses. The medical expenses reimbursement amount can range from a per day cost and set percentage to the actual costs of the medical expenses.
• Preferred Provider Organizations (PPOs): These plans contract with a network of hospitals and doctors who provide services at a negotiated rate. This means you have access to any PPO provider in the network, whether a primary care physician or a specialist. PPO members can go to doctors or hospitals that are not in the network but will have to pay a higher cost for doing so. This is a great plan if you are looking for insurance that is both affordable and flexible.
• Health Maintenance Organizations (HMOs): With these managed care plans, you will have a primary care physician (PCP) who is responsible for managing all of your health care. If you need to see a specialist or someone else in the network, you need a referral from your PCP. Treatment received outside the network is generally not covered, or is covered at a significantly reduced level.
  Point of Service (POS) Plans: These medical plans are a combination of the PPO and HMO models. Like an HMO, there is a PCP providing referrals to in-network doctors. Like a PPO, you can see providers outside the network and pay more of the cost.

Both accounts are tax-advantaged, but an HSA is more “flexible.” The money in an HSA is the employee’s and is still available after changing jobs or retiring. It can rollover from year to year and does not have the use-it-or-lose-it requirement that an FSA has.

If your company employs less than 25 full-time equivalent employees, you may qualify for premium tax credits under the ACA’s small-business provisions. In addition to employing less than 25 full-time workers, the average income of these workers must be less than $50,000. If your small business meets these qualifications, you may be eligible to receive a tax credit, but you can only receive this tax credit via the SHOP marketplace. Companies that choose to insure via the private market will need a different solution to offset costs.

Medicare Advantage Plans are comparable to the managed care health maintenance organizations and preferred provider organization plans you may have had while working. They include Medicare Plan B outpatient and doctor visit services as well as parts from original Medicare, like emergency and urgently needed care. Most include prescription drug coverage (Medicare Part D). In addition, some Medicare Advantage Plans offer coverage for vision, dental, hearing and/or wellness programs.