In the ever changing landscape of Texas Health Insurance and Employee benefits, we have been presented with some weird stuff on health insurance policies. Many Texans are convinced that the only way for them to have good health insurance is through their employer. And when they get a policy that reads like a confused fortune cookie written in a language that they don't understand, they begin to wonder what is left. So what can you do?
My Health Insurance At Works SUCKS!
During the fourth quarter of every year it seems like almost every company goes through their open enrollment for benefits. And with that process comes the news about what is being done to the health insurance plan to "keep costs down". Then the documents stating premiums, deductibles, copays, coinsurance, and maximum out of pocket come rolling through and you feel confused. We have good news. There is a path to comparing plans.
Let's look at what your guaranteed costs are for the year with each plan.
- Guaranteed Costs (You pay no matter what happens in between)
- Monthly Premiums
- Prescription Costs
- Copays for things you know you will use
- Visit Costs If Not Covered
And then also what you could be out if you had a major health event.
- Variable Costs For A Major Event (This is the bad stuff that can bankrupt you)
- Deductible Amount
- Coinsurance Amount
- Copays for things like ER visits that don't count towards your deductible
- Deductible + Coinsurance = Maximum Out Of Pocket Costs
Take the total for each plan and see what your range of commitment is for each plan that you are evaluating. This will allow you to see not only recurring, regular costs, but will also see the downside potential. Knowing this potential will expose if your health insurance at work actually sucks because you can compare it to other plans.
So My Work Plan Isn't Great. What Can I Do Now?
If you compare your current work plan to even the policies on the Affordable Care Act Exchange and determine that you can do better, what do you do now? The great news for you is that there are options in Texas that allow you to take control of your health care and the insurance that most feel is necessary to be protected from bankruptcy. When people call our office, they always want to know what their options are beyond the exchange and work plans. So let's take a look at what those are for Texans.
- Go Uninsured - We put this simply to say it is an option. Just a dumb one today. There are many options to choose from. Do not take this route.
- Health Share Plans - These plans became very popular when the tax mandate was put in place to force people to buy health insurance. Though not true health insurance, these were considered compliant for the mandate purposes. They allow people with common interests to share health care costs and pay for the routine out of their own pocket.
- Traditional Individual Health Insurance - These plans are making a comeback now that the tax mandate has been removed. We are seeing the big health insurance companies bring these plans back to market. It may be a bit more expensive than your work plan, but can provide you exactly the benefits you want to receive.
- Short Term Medical Insurance - These are fully underwritten health insurance plans that were created to provide coverage outside of Open Enrollment for the Healthcare Exchange. They offer a variety of options for true health insurance, though many of the plans exclude some key coverage that many feel important like mental health or maternity benefits. They work great, but can only be used for up to three years currently.
- Catastrophic Health Insurance - There are many myths about Catastrophic Health Insurance floating about. It does exist and it does protect you from those big events which can derail your life. It doesn't get involved in your routine care at your Primary Care Physician, so you don't have to worry about networks. But you do need to be prepared to pay for those visits out of pocket, which is a foreign concept to many people after all of these years of copays and "free" wellness checks.
That's Great! So Which One Should I Choose?
Which alternative path is a very subjective manner. If you have a dreaded pre-existing condition it will reduce what options are available to you. But keep in mind that not all conditions are knock outs from coverage, so speak with an agent who actually can sell you those kinds of policies.
The reason that we believe that better is a subjective decision is that not all out of pocket costs are the same. We have seen local Texans utilize Direct Primary Care to manage all of their routine items in a very cost effective fashion. That concept pairs extremely well with a Catastrophic Health Insurance plan for a very cost effective solution when compared to traditional insurance. On the converse of that, a Short Term Medical Plan has enough flexibility today to provide you a more traditional copay type situation. And there is always that Traditional Individual Health Insurance plan as well.
So What Do I Do?
We recommend working with a health insurance agent who can present multiple options to you. Having options allows for the agent to work as a fiduciary on your behalf. They can present both the positives and negatives without an agenda to make sure that you can make the best decision for you and your family. As independent insurance agents, Insurance For Texans functions in this kind of role. If you would like to explore your options, just click the button below to see what is available to you.