Health Insurance For Texans Basics
Tired of confusion about what policy does what? Read on!
Have you ventured out to do your own gig? Own a business? Work somewhere that doesn't offer coverage? There are options for health insurance in the great state of Texas.
- Did you know that over four million Texans are without health insurance?
- Did you know that you can get individual health insurance that does not come from the government exchange?
- Are you only worried about major expenses and tired of subsidizing others' well care?
- Did you know that you have multiple options to obtain health care?
The agents at Insurance for Texans works with a matrix of policy options and companies so that we can provide you the health insurance coverage you need and desire in the most cost effective fashion.
This means that you can customize a plan that fits your family's needs rather than take a one size fits all approach!
Over the last 15 Years, individual health insurance in the state of Texas has gone from a little bit crazy to insane to navigate easily. We've spent the last few years assembling the best options possible for you to choose from.
So What Are My Individual Health Insurance Options In Texas?
Affordable Care Act Exchange
If you are not able to obtain coverage through an employer or association, one of the first things to consider in the current environment is to evaluate your options on the Exchange. For many, especially if subsidies are in play due to income levels, this can actually be a great option. There are five main considerations with Exchange plans.
- If you have a pre-existing condition, this will absolutely be your best option available since there are no exclusions.
- Your zip code can make all the difference in the world since some plans/networks are only available in specified zip codes.
- Open Enrollment for a calendar year occurs during November and December. Plan accordingly if you don't have a qualifying life event.
- These plans are required to provide preventive care, maternity/childbirth care, mental health care, and prescription benefits.
- This is not medicaid or medicare coverage thought it is regulated heavily by the government.
With those considerations in mind, it may make sense for you to stop here on your list of options. These plans do not have lifetime maximums and are both guaranteed issue and guaranteed renewable year after year. If you are dealing with a long term health situation it will make your life easier and better.
When the affordable care act was put in place in 2010, the Exchange referenced above was born. Since it had Open Enrollment as it's vehicle to obtain coverage, the politicians quickly realized that people could roll off of coverage mid-year and need an interim solution. Short Term Medical Plans were born. They've gone through some overhaul in the last two years as a result of changing legislation, but the result has been good for consumers. There are
- These plans are underwritten which means that a pre-existing condition could prevent you from obtaining coverage!
- These plans can be for as short as one month or can be extended for up to a year.
- The diversity of plans available is helpful. Deductibles range from $1,000 to $25,000 and some plans include co-pays for office visits.
- These plans can be non-renewed in the event of a major condition diagnosis mid-term
- These plans will have a maximum lifetime benefit amount.
Beyond that, the networks are good and are based on a PPO type policy. They do not cover preventive care or prescriptions in most instances, but for many the savings are phenomenal and more than make up for any out of pocket costs. They can be paired with ancillary coverage like dental and critical illness policies to provide a robust package.
A type of health insurance plan that is making a comeback is Catastrophic Health Insurance plan. These plans are traditional major medical policies that are focused on the big expenditures that from accidents, critical illnesses, and hospitalizations. For those that "never go to the doctor" and just want to make sure that a major event does not ruin them financially it can be an excellent option. That's because they do not interfere with regular doctor visits or minor acute care. The plan is built off of three main pillars.
- Critical Illness provides protection against major illnesses in life that create large medical costs like stroke, heart attack, and cancers.
- Accident provides protection against hospitalizations that occur from car wrecks, sports accidents, or other major trauma to the body.
- Hospital Indemnity provides defined benefits to cover out of pocket expenses as well as costs associated with surgeries and hospitalizations.
These plans are underwritten, so pre-existing conditions do come into play. However, they work extremely well with the world of Direct Primary Care. They are VERY cost effective since they do not involve themselves with primary care and minor acute visits. As a result, they make a great option for the budget conscious, the young and healthy, and those pairing it with very regular care from a PCP.
Health Share Plans have been around for several decades. Traditionally they have been faith based and were focused on those living a certain life style that limited exposure to certain health care events due to that lifestyle. The plans are focused on the sharing of major health care costs beyond primary care and as a result tend to be cost effective. The plans began to explode in popularity as the Affordable Care Act Tax Mandate went into effect during the 2010's. As a result, there was proliferation of options, share plans, and some that were not faith based. However, there are some drawbacks to these plans that have to be mentioned.
- These plans ARE NOT actual insurance. This means that you have little recourse if they don't actually execute on the contract.
- Pre-existing conditions can be excluded while you can be covered for everything else.
- Since the premise of these plans is to reimburse you for things you pay for, it can create an interesting cash flow situation in a major event such as on-going cancer treatment.
These plans are not for everyone, but we can definitely break down the pros and cons of many of the major ones. They can be a great solution, but you also have to tread lightly as there have been some major problems when due diligence is not performed.
If you would like to learn more about the health insurance options available to all Texans, we recommend doing a preliminary fact finding call with our agents. Each situation is as unique as the Texas landscape and we appreciate that. As a result, there is some basic info that we would need to discuss. Click the button below to schedule that consultation.