Health Insurance in Texas

Are you looking for affordable health care coverage in Texas? We understand that the search for insurance can be a complicated one. But you’re not alone. There are millions of people just like you who are in need, and our health insurance experts are eager to help. Below, we’re going to discuss all of the different options that Texans have these days. Once you finish reading, you’ll learn a ton of information that you need to know in order to make a good decision for properly insuring you and your family. 

Major Medical Insurance in Texas

If you can’t get major medical health insurance through your employer, then you might want to join the increasing number of Americans in searching for health care coverage via the Health Insurance Marketplace. Also known as the Exchange, the Health Insurance Marketplace has established thanks to the Patient Protection and Affordable Care Act which passed back in 2010. This act, commonly referred to as Obamacare or the ACA, established both the Marketplace and the guidelines by which insurance companies must adhere if they want to sell insurance products to a fresh, new market of consumers who are waiting and eager to get covered.

It’s actually fairly simple to get covered by this type of insurance. All you have to do is go to HealthCare.gov and fill out a quick and easy application. It usually takes less than an hour to complete, and you can get results that same day. But you’ll want to make sure that you fill out your application during the Open Enrollment period each year starting on November 1st. For 2020 coverage, Open Enrollment ended shortly after December 15th, 2019. But if you need coverage now and can’t wait until next fall, contact somebody via HealthCare.gov and talk to them about special enrollment periods (SEPs). You might have a qualifying circumstance that can allow you to enroll outside of Open Enrollment. 

The first thing to talk about when it comes to ACA insurance is the fact that these policies are all guaranteed issue. Guaranteed issue policies are good for people like you and your family because once you get approved through HealthCare.gov to apply for coverage, you cannot be rejected, even if you are applying with pre-existing conditions. Your insurance company will also have fewer excuses to charge you more on your monthly premiums compared to healthy customers without pre-existing conditions. As a matter of fact, the only reasons an insurance company can justify charging you more for your monthly premiums are based on the following:

• Your age 
• Your location
• Your use of tobacco products
• Whether you are applying for an individual policy or a family policy

The next issue to discuss is the list of guaranteed Essential Health Benefits which come with every single ACA policy. A comprehensive list of those benefits is below. With all of these benefits, you will have everything you need at your fingertips to be able to get preventative care in order to maintain optimal health and wellness for you and your family. This can help you manage chronic conditions, help you get healthy and stay healthier for longer, and lower your total medical costs over the long-term.

• Ambulatory/outpatient services
• Emergency services
• Hospitalization
• maternity/newborn care
• Mental health and substance abuse
• Prescription drugs
• hab/rehab services and devices
• Lab tests
• Preventive and wellness services and chronic disease management
• Pediatrics (including oral and vision)

Lastly, you have the fact that these insurance policies are made affordable thanks to government subsidies which have been specifically set aside to help working families and individuals afford the best possible coverage. Without these subsidies, many find ACA insurance prohibitively expensive. But if your household makes at least 138% of the federal poverty limit on an annual basis, you could qualify for a generous premium tax credit which helps lower the total price of your monthly premiums. Consult the chart below for more information on whether or not you qualify. If you make 100% of the federal poverty limit or below, you won’t qualify for a tax credit but you could be eligible for Medicaid in Texas. To find out more information on that, simply visit the Texas Health and Human Services website for Medicaid and CHIP.

There are some people in Texas, though, who might not be able to either qualify for a subsidy or apply for Medicaid. Those people fall into what is known as the Medicaid expansion gap. Texas is one of a few states which still refuses to accept free federal funds which have been specifically set aside in order to expand Medicaid to needy families making 138% or less of the federal poverty limit. Until the law changes or their income does, people who fall into this gap will have to search for other options as far as their health care is concerned. Some of those options include things like short-term health insurance, health share plans, indemnity plans, and more.

Short Term Health Insurance in Texas

People in Texas might first want to look at short-term health insurance, especially if they would like to get major medical coverage through the ACA but have to wait until the next Open Enrollment opportunity for whatever reason. Short-term health insurance in Texas allows consumers to purchase 364 days straight of coverage with the option to renew for up to two years. But in order to apply for coverage, you will have to undergo medical underwriting, which is the exact opposite of guaranteed coverage. Any pre-existing conditions you have could disqualify you for coverage, or you could end up paying substantially higher monthly premiums if you aren’t in perfect health. Short-term health insurance also tends to come with very high out-of-pocket deductibles which you must pay before you start receiving benefits. Lastly, the vast majority of short-term health insurance companies probably won’t sell you all of the Essential Health Benefits, even if you ask to purchase them. These are the shortcomings you should know about before deciding upon a short-term health insurance policy.

But short-term health insurance isn’t all bad. There are some benefits that might be of use to you if you decide to go this route. For starters, your monthly premiums could cost up to 1/3 less compared to an unsubsidized ACA policy, which might make such coverage affordable for you and your family. Unlike a health share plan, you get consumer protections with short-term health insurance so that you can take your provider to court if they unjustly deny you your benefits. You can combine short-term health insurance with something like an indemnity plan in order to help limit your total out-of-pocket costs. And although you might not be able to purchase all of the coverage you might need, you should still have the option to negotiate with your provider and purchase additional coverage if it is not automatically offered with their basic plan. These reasons and more are why lots of people in Texas decide to settle for short-term health insurance in order to help meet their health care needs. 

Christian Health Plans/Health-Sharing Plans in Texas

Here’s a bit of good news you might not know: as of the beginning of 2019, the individual mandate was no longer federal law. The individual mandate was enforced during the early years of the ACA, charging taxpayers a financial penalty if they didn’t purchase insurance through the ACA or get qualifying coverage through their employer. Back when it was still law, though, it made health share plans that much more attractive because the religious nature of health share plan providers offered a religious exemption to the individual mandate for anyone who purchased a plan.

It’s important to recognize, however, that just because they received an exemption doesn’t mean that these policies qualify as equivalent coverage to the ACA. As a matter of fact, health share plans tend to have more in common with short-term health insurance than they do major medical coverage. Here are all of the similarities you can look forward to if you choose a health share plan over a short-term health insurance policy: 

• Less expensive “monthly share amount” (which is the equivalent of a monthly premium for major medical)
• No guarantee issue available
• Not all 10 Essential Health Benefits will be available
• Not considered to be “real insurance”
• Most plans have lifetime and annual benefit caps
• No caps on out-of-pocket costs

But you should also familiarize yourself with how these plans are different, because they are certainly not created equal. According to the strict legal definition of the law, there is no contract between you and a health share plan provider, so it cannot be legally enforced. This means that you can’t take them to court if you feel that you have been unjustly denied your benefits (the way you could with a short-term health insurance company). You won’t be paying co-pays, deductibles, or co-insurance with a health share plan; instead, those charges are labeled as “unshared amounts” or “personal responsibility amounts”. You’ll also be paying a “monthly share amount” instead of a monthly premium, although the purpose of this payment is still basically the same. Health share plans are issued by faith-based organizations, and you will have to follow certain participation guidelines in order to remain in good standing and continue receiving benefits. Sometimes, these guidelines are as simple as declaring a specific religious faith and attending church regularly. Other guidelines may request that you cease tobacco use or make other changes to your lifestyle in order to get healthier and require less expensive medical care. 

Fixed Indemnity Plans in Texas

Fixed indemnity plans are not an adequate replacement for major medical insurance; they can, however, be a helpful supplement to have right alongside major medical coverage or some sort of equivalent. Instead of paying out a fixed percentage of your total medical costs, they pay out a fixed amount of money per claim. These claims are paid out on a daily, weekly, monthly, per incident, or per event basis. Some indemnity plans include hospital benefits, doctor benefits, dental benefits, or some combination thereof; but they don’t come close to covering the 10 Essential Health Benefits that are available through the ACA. Another good thing about fixed indemnity plans is that they aren’t limited to specific medical networks. This is why they work well as a supplement – because if you can’t find the care you need in your provider’s HMO or PPO network, indemnity plans allow you to go outside of those networks and get care at a reduced price as long as they agree to the payment terms of your indemnity plan provider.

Not unlike some of the other options we’ve discussed so far, you’ll have to go through medical underwriting with a fixed indemnity plan. You’ll also have to deal with annual and lifetime benefit caps, but no caps on your out-of-pocket costs. Out of all of your options outside of the ACA, fixed indemnity plans probably pay for the smallest share of your total medical expenses. That being said, it’s still better than nothing. Even if you are relatively healthy and don’t anticipate any serious need for medical care anytime soon, it can be a good insurance policy to have in your back pocket just in case the unexpected happens. 

Discount Cards in Texas

Medical discount cards have the potential to help you save some money off of your out-of-pocket expenses – but at the same time, there are a lot of fraudulent products out there that you need to be wary of. With a little education, though, spotting a medical discount card scam is easy. First of all, if the company markets their card as a replacement for health insurance, they’re lying. Secondly, if the discounts they promised or the network of providers they claim to work with seems too good to be true, it most likely is. You can follow up and call up the providers they claim to work with and ask about the discounts you might receive with their discount card. Doing this will help you discover whether or not their claims are fraudulent or whether you might actually get a good deal if you purchase a medical discount card from that company.

Here’s how medical discount cards actually work: you purchase a membership by paying a monthly or an annual fee, not unlike a Sam’s Club membership or the AAA Club. They will send you your discount card in the mail, and you must present it whenever you’re at a qualifying retailer or provider getting medical supplies, prescription drugs, or medical care. You’ll get a discount right there at the register. There are no claims to file, and no reimbursements to wait around for. But these discounts are usually fairly moderate, and you might require a lot of medical care, prescription drug purchases, and more in order to save enough money on discounts to justify the price of the membership. Just keep all of these facts in mind when you sit down and think about whether or not you want to purchase a medical discount card in Texas.