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Texas Health Insurance Plans

There are many different types of health insurance plans available in Texas. Let’s take a look at some of the top Texas health insurance plans and see which type of plan will best meet you and your family’s health insurance needs.

Types Of Texas Health Insurance Plans

There are 3 main types of Texas health insurance plans: the copay plan, thedeductible only plan, and health savings account (HSA) plan. The easiest way to compare these 3 main types of Texas plans is to see how the plans would cover these 2 scenarios: a $200 Doctor’s visit and a $50,000 medical bill for surgery. We will also compare their approximate monthly premium costs in relation to each other.

The Texas Copay Plan – This type of plan will typically have a copay plan for Doctor’s visits and prescriptions. This means that for the $200 Doctor’s visit if the copay plan has a $25 copay for Doctor’s visits then $25 is all that you will ever have to pay. For the $50,000 medical bill it will all depend on the out of pocket maximum that the copay plan has.

Typically, you will first have to meet your deductible (copay plans still have deductible as copays are only for Doctor’s visits and prescriptions – not for things like broken legs or surgery in this case) and then some form of coinsurance will kick in, usually 80/20, where the insurance company will pay 80% and you will pay 20% up to a certain limit.

So if you are with a strong reputable Texas insurance company then you will probably pay anywhere from $5,000 to $10,000 out of pocket for the $50,000 medical bill and the insurance company will pay the rest (watch out for indemnity policies which offer very limited benefits).

Texas copay plans are the most expensive of the 3 types of Texas health insurance plans.

The Texas Deductible Only Plan – These plans are the most straightforward out of all of the plans. You pay everything until you reach your deductible and then once you reach your deductible for the year the insurance company pays 100% (although some Texas deductible only plans do have a coinsurance feature which will make the monthly premium less expensive but your maximum out of pocket cost higher).

In the $200 Doctor’s visit example you will pay the whole bill (or the lower negotiated rate by the insurance company) until you reach your deductible. In the $50,000 medical bill example you will pay everything until you reach your deductible and then the insurance company will pay 100%. Therefore, with no coinsurance your out of pocket cost will always be equal to the plan deductible (if your deductible if $1,000 then you will pay $1,000 of the $50,000 and the insurance company will pay $49,000, if your deductible is $2,000 then you will pay $2,000 of the $50,000 and the insurance company will pay $48,000).

Everything else being equal, a Texas deductible only plan will be cheaper than a Texas copay plan (because the copays cost extra monthly).

The Texas Health Savings Account (HSA) Plan – This plan has two components; the insurance component and the savings account component. The insurance component is exactly like the Texas deductible only plan described above (although it can never have the coinsurance feature –a good thing – which means that your maximum out of pocket for the year is always equal to the plan deductible).

The savings account component is simply an account that you can contribute to over and above your monthly premiums that will give you some tax benefits. The higher your tax bracket the more advantageous the HSA plan is for you from a tax perspective.

The Texas HSA will be very close in price to the Texas deductible only plan.

Which type of plan should you choose? Why not take a few moments and compare all of the different types of plans from Texas health insurance companies that offer coverage in your zip code? Use our free TX quote finder to request free Texas health insurance quotes now!

Basics Of Texas Health Insurance Plans

A simple way to look at basic Texas health insurance plans is to know that all insurance carriers have to comply with Texas law.  The companies are regulated by the Texas Department of Insurance.  With that in mind, understand that usual and customary allowances are established for each medical procedure honored by health insurance plans in TX.

Most group and individual plans give its subscribers the option of:

  • Health Maintenance Org. (HMO’s)
  • Preferred Provider Org. (PPO’s)
  • Point of Service (POS’s)
  • Traditional Fee-for-service

HMO’s and PPO’s are health maintenance organizations that pay the network of service providers from the premiums collected from subscribers.  Point of Service and Traditional fee-for-service plans require the subscriber to pay for services at the time of service.

Texas Health Insurance Plans Using HSA’s And HRA’s 

Heath Savings Accounts and Health Reimbursement Arrangements are popular options especially among groups.  HSA’s are tax free ways to say for meeting high deductibles when saving on premiums.  They are also intended for major medical and auxiliary charges not covered by your carrier.

HRA’s are arrangements made by the insurance subscriber, the carrier, and a third party to reimburse the subscriber for all qualified medical charges incurred.  These plans prompt accountability and cost consciousness by the subscriber.  The problem with them is developing the motivation to make regular contributions to the account.

Short Term Texas Health Insurance Plans

Short term Texas health insurance plans are important to have access to in many instances.  Some examples of those instances might be:

  • A student in college (no longer eligible for parent’s plan)
  • A recent graduate student
  • An employee that is between jobs and does not have COBRA
  • New to a job and waiting on open enrollment
  • Part-time or temporary worker

Short term policies can become effective immediately as they do not accept preexisting conditions.  They are able to keep the premiums at a minimum for that reason.  One popularly known short term plan is COBRA which is an interim plans for those transferring from one job to another.  COBRA can be as much three times as much as you probably paid on your job.  If it is unaffordable, another short term Texas health insurance plan might be best.

Discount Texas Health Insurance Plans 

It is important to know that discount Texas health insurance plans are not insurance plans at all.  These plans are small networks of providers willing to accept discounted rates on services to be a member of the plan.  Discount plans are good if no insurance plan is available.  Some of those instances are:

  • Dental discount plan
  • Vision discount plan
  • Medical discount plan
  • Prescription Drug plan

Discount plans usually offer up to a 25% discount on services.  They do not insureand therefore pay for medical services not paid by the card holder.  These types of plans are good for individuals or as supplements to existing plans where these benefits are not offered. 

Self Funded Texas Health Insurance Plans

Because of the rise in Texas health insurance rates, Texas businesses have ended up funding their own group plan for their employees.  The employer pays 100% of the medical expenses of its employees as opposed to utilizing HMO’s or Insurance companies.  They are regulated by ERISA or the Employee Retirement Income Security Act rather the Texas Dept. of Insurance.

It is important for the employer to be insured even if health insurance can not be offered to employees.  If a catastrophic event happens to the business owner, it jeopardizes the survival of the business itself.  

Texas Health Insurance Plans Using (MEWA’s) Multiple Employer Welfare Arrangements 

Small and medium sized companies sometimes mobilize their resources to provide Texas health insurance plans to their employees.  These types of plans are composed of premiums contributed by a multiple number of employers for employees.  The purpose is to spread the high risk costs out among the businesses.

Although all insurance companies are regulated by the Texas Department of Insurance, and therefore have to charge the same rate, the difference is in the underwriting of the policy.  That means the condition of your health has an impact, unless you’re a group where other’s health will also be considered.

Compare Texas Health Insurance Plans Now!

Start your research on Texas health insurance plans for your business now by clicking on the free quote tool at the top of this page.

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