Although Texas is one of the states that ranks the highest among U.S. states in the number of uninsured residents, obtaining affordable Texas health coverage is easier and more affordable than most Texans believe. Here are answers to five common questions about getting health coverage in Texas.
Since I’m young and healthy, do I need to pay for health coverage?
Having health coverage is like carrying around an umbrella. You might not need it most of the time, but when there’s a major storm you’ll be glad you have it. Even young and healthy people have occasional accidents, seasonal illnesses, allergies, and sometimes unexpected tragic health issues.
By any chance, if you end up having a serious medical condition, it can become very difficult to obtain coverage, or your preexisting condition may be excluded from your coverage. In addition, it is best to prepare for the unknown, and you can get much lower premiums when you’re young and healthy. Having health coverage helps to protect you from major financial out of pocket expenses in case of an accident or emergency, so it is best practice to find coverage, even if you may not need it right away.
Do I need a broker or an agent or can I compare different insurance companies on my own?
Although it is possible to navigate the health coverage marketplace on your own, many people quickly become overwhelmed with the options and confused with the acronyms, uncommon terms, coverage details, exclusions, premium pricing, and much more. For example some people do not know the difference between a PPO and HMO, and these type of details can make a big impact on what plan is right for you.
A licensed Texas broker provides a number of benefits and can make it simple to find the right plan. Most agents have established relationships with many, many insurance companies, and are very familiar with the market. This means that they have access to view and compare plans across Texas, while not having a bias toward any single provider.
This is in contrast to some individual health agents, who work on behalf of a specific company and only recommend plans from that are offered through them.
Again, while it is possible for you to research various plans on your own, a Texas licensed health agent can do the legwork for you and present you with all available options, at no extra charge to you. They are great resources and are generally compensated by the company that you decide to choose
What’s the most important thing to look for when looking for health coverage?
While many variables come into play, the most important factor for most people is the cost of coverage. There are two important factors that people often overlook: the lifetime maximum coverage and the maximum out-of-pocket expense.
Many peoples immediate concerns might be co-payments for doctors’ visits and prescription coverage, if you or a family member experiences a catastrophic illness, overall coverage and out-of-pocket costs are much more crucial.
We recommend to look for a policy that offers lifetime maximum coverage of $2 million or more, and a yearly out-of-pocket maximum in the $2,000 to $4,000 range, or something that feels affordable and viable to you. Keep in mind there are also other options to purchase supplemental coverage, which can supplement your benefits and make your deductibles as low as $500 out-of-pocket expense.
Can I trust online comparisons for Texas health coverage?
Yes, Texas is a highly regulated state and the law requires that identical plans have identical pricing, regardless of whether you go directly through the insurer or use a health agency or agent.
In other words, if you’re looking at the ABC company’s Plan A, you will receive the same quote whether you do it online, over a phone call, or visit an agency or company.
Keep in mind that the premium prices may vary based on a number of variables, including your age, your gender, whether or not you smoke, family health history, and any pre-existing medical conditions that you may already have. The final price of your premium is in large part determined by your medical history.
What’s the main difference between an HMO and a PPO?
When it comes to Texas health coverage, a health maintenance organization (HMO) requires that, for non-emergency services, you use their physicians and hospitals in order to be covered. This can create a conflict if you move, or something happens while you are traveling, or you switch to a different job.
A preferred provider organization (PPO) allows you to visit any health care provider, yet does give you more benefits if you use health care professionals and services within their network. If you have doctors that you have been seeing for a long period of time, we recommend selecting a PPO network with nationwide coverage.