Texas Health Insurance Overview

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Best Health Insurance Texas Overview

Texas is officially nicknamed as “The Lone Star State” because it indicates its past status of an independent republic and as a reminder of the endeavor to attain independence from Mexico. It is the second largest U.S. state and also second highest in population. Unfortunately the state owned the distinction of having maximum uninsured population in the country and is also considered among the worst states in the U.S. for health care. Thus, this Lone Star State need to considerably improve as far as taking care of their health is concerned. More and more residents of this state need to enroll in health insurance plans so they don’t neglect their health at the time of medical emergency. Individuals looking for health plans can use HealthCare.gov for enrollment, as the state utilizes the federally run marketplace and has the highest exchange enrollments in the country. It is only behind Florida and California as far as higher exchange enrollment is concerned. In Texas, open enrollment for 2020 health plans has ended and only residents with qualifying events can enroll or make changes to their coverage. The next open enrollment period in Texas for health plans that will be effective in 2021 will start from November 1, 2020.

Highlights and Updates on Texas Health Insurance

  • In Texas like other U.S. States open enrollment for 2020 health plans has ended and only residents with qualifying events can enroll or can make changes in their plan for 2020 coverage.
  • Open enrollment for health plans that will be effective in 2021 will begin from November 1, 2020.
  • The Texas state facilitates the federally run marketplace and its residents enrolled using HealthCare.gov.
  • Texas was among the few states, where enrollment through HealthCare.gov grew in 2020.
  • In Texas short-term health plans are available, having initial plan terms of up to 364 days, as the state align with the federal rules.
  • The health insurance premium in Texas are little lower in 2020 compared to 2019.
  • In Texas eight insurance carriers are offering health plans through the Texas exchange and two insurance carriers offer plan off-exchange.
  • More than 1.1 million people enrolled during the open enrollment in 2019 for obtaining coverage in 2020.

Individuals & Family Health Insurance Plans in Texas

Residents in Texas looking for individual and family health insurance plans can purchase these plans from participating private insurers through HealthCare.gov, the federal exchange. Individual and family plans are usually taken by individuals who are self-employed with no employees, students who are not covered from their parents coverage and people who don not obtain coverage from their employer or individuals who are unemployed. All qualifying plans available in Texas for individuals and families must offer ten standardized essential benefits along with the state additional mandated benefits. The following types of individuals and families health insurance plans are available in Texas, which can be purchased through private providers or providers participating in Texas through the federal exchange, HealthCare.gov.

PPO – Preferred Provider Organization or PPO plans are amongst the most popular plans in the Individual and Family health insurance market. People prefer this type of plan because they enjoy complete flexibility and are allowed to visit any in-network physician or healthcare provider of their choice without any need to obtain a referral from their primary care physician. However, people should keep in mind that in-network healthcare services will include higher benefit level compared to out-of-network healthcare services. Before enrolling in any of the PPO plan, it is vital for the insured to check that their provider accepts their health plan to receive the highest level of coverage. PPO plans require insured to pay an annual deductible before they start covering their medical bills and the insured might also need to pay a co-payment for certain services or they need to cover a certain percentage of the total charges of their medical bills.

HMO – Health Maintenance Organization or HMO plans render several healthcare services through a network of healthcare providers who agree to provide medical services to the members of the plan. Individuals enrolled in an HMO are likely to receive coverage for different preventive healthcare services compared to any other type of plan. Members of HMO plans need to choose a primary care physician, who not only take care of their healthcare needs but also provide a referral for visiting a specialist. Individuals enrolled in HMO plans have lower out-of-pocket healthcare expenses, as they may not have to pay a deductible before the start of their coverage and they may also have minimal co-payments. HMO plans enrollees don’t require to submit their claims to the insurance company, as healthcare providers submit the claim to the insurance companies on their behalf. Members of HMO plans should keep in mind that there is no coverage for services rendered by out-of-network providers or for healthcare services that are rendered without a proper referral from PCP.

POS – Point of Service plans come with the combined qualities of PPO and HMO plans and the benefits received usually depend whether members have received healthcare in or out of the health insurance company’s network of providers. Since, POS plans combine features of both HMO and PPO plans, members are required to choose a primary care physician who take care of their health and provide referral for visiting a specialist. Members of POS plans may also receive healthcare from non-network providers like a PPO plan but with greater out-of-pocket costs and they will also be responsible for coinsurance, co-payments and annual deductible. Depending upon the type of POS plan, services provided by PCP include preventive care benefits.

HDHP with HSA – Individuals who wish to have affordable healthcare plan and also look to save for retirement are provided with the option of Health Saving Account. It is a tax-favored savings account used along with high-deductible HSA-compatible health plan in which Texas residents can save to pay for qualified medical expenses with pre-tax dollars. Their deposit in this account reduce their taxable income and their withdrawals for paying qualified medical expenses are never taxed. Thus with Health Savings Account, individuals can reduce their both out-of-pocket costs and tax burden. However, withdrawals for non-medical purposes will be taxed and also impose a penalty.

Fee-for-Service Plan – Fee-for-Service plans are also referred as Indemnity plans, which allow individuals to manage their healthcare and also allow them flexibility to visit any doctor or hospital of their choice and they would also require no referral for visiting any specialist of their choice. In Fee-for-Service plans members are require to pay up-front for the received healthcare services and then submit a claim to their insurance company for the reimbursement. Individuals are required to pay an annual deductible before receiving reimbursement from their insurance company. Once the individuals met their deducible, the insurance company pays at a set percentage of the usual, customary and reasonable rate for the received healthcare service. The usual, customary and reasonable rate is the amount that the healthcare providers of the insured area usually charge for the healthcare service received by the insured.

Short-term Health Plans in Texas

Short-term health plans in Texas just like any other states was designed to provide coverage for people who are in between coverage options, waiting for employer coverage to start, recent college graduate, traveling outside of network area or a dependent who is no longer covered under parents plan. Short-term health plans are low cost health plans that are immediately approved and have initial term of up to 364 days and can be renewed for a total duration of up to 36 months. The short-term plan rules align with the federal rules and so the renewals are allowed in line with federal guidance. However, individuals looking to purchase short-term health plans should keep in mind that short term health plans typically do not cover any pre-existing conditions or benefits offered by comprehensive plans under ACA act. In addition to this short-term plans also do not guarantee renewal, so if the insured develop any medical problem while being on a short-term plan, then the insured will not be able to renew the plan or they may also be excluded from the policy. Thus, this plan is not ideal for everyone and suits only to those individuals who only need minimal coverage and prefer to save on health insurance cost. Individuals should also remember that having short-term plans also make them ineligible for the guaranteed issues like HIPAA and COBRA plan.

Dental Insurance Plans in Texas

Residents of Texas who don’t have dental coverage included in their health plans can shop for dental insurance plans, as the state has some really good dental insurance plans that provide people with dental care and preventive care benefits like regular checkups, cleanings, x-rays, and other services essential to promote general dental health. However, the dental benefits and coverage differs from plan to plan, as some dental plans provide broader coverage and some plans have greater co-payment attached to it. Dental insurance plans in Texas are often categorized as:

Indemnity Dental Plans – Individuals enrolled in indemnity dental plans in Texas are offered with a greater flexibility, as they are free to visit the dental care provider of their choice. Individuals enrolled in this plan may have to first pay up front and later on they can obtain reimbursement from their insurance carrier. The insurance carrier pay for the covered services only after receiving the bill.

Managed Care Dental Plans – Managed care dental plans maintain a network of dental care providers and all the participating dentist of the network agree to perform services for patients at pre-negotiated rates. The participating dentist generally submit the claim to the dental insurance company on behalf of the insured. With managed care dental plans, insured usually have less paperwork and lower out-of-pocket costs.

Vision Insurance Plans in Texas

Vision insurance plans in Texas are designed to provide individuals with eye care coverage like regular eye check ups, annual eye exams, cost of eyeglass frames and lens or even contact lenses. These plans help individuals save on eye care costs. Individuals looking for vision insurance can purchase plan anytime during the year and not just during open enrollment period. Stand-alone vision coverage can’t be obtained through healthcare.gov but is offered on state-run exchange. Vision plans just like health plans have a network of eye care providers, optometrists and ophthalmologists, who provide eye care services at a pre-negotiated price. Some of the vision plans also cover specialized services like refractive surgery, LASIK, and other vision-correction procedures. Using an in-network eye care provider will save insured money, however insured will require to meet a deductible before their benefits take into effect.

Insurance Carriers in Texas

There are eight health insurance companies offering plans through the Texas exchange and two health insurance companies are offering health plans off-exchange. These companies are as follows:

  • Oscar Health
  • Ambetter
  • Blue Cross and Blue Shield of Texas
  • CHRISTUS Health Plan
  • FirstCare Health Plans
  • Molina
  • Scott & White – Off exchange
  • Vista360 Health – Off exchange

Representatives are available