The Benefits and Drawbacks of Texas Health Plans

Almost one in four Texas residents does not have health insurance. Fortunately, the state has a variety of options for gaining access to healthcare.

Those seeking coverage for themselves and their families may choose from plans on the Health Insurance Marketplace. Those who qualify for Premium Tax Credits can receive financial assistance towards their monthly premiums.

Cost

The cost of Texas Health Plans can vary significantly based on your age, coverage level and income. Premiums may be lower for older individuals or those who have medical conditions.

Choosing the right plan can help you save money on healthcare costs and make sure your insurance policy covers all of the services you need. Choosing the right plan can also mean less stress when you have an emergency or unexpected medical expense.

In Texas, marketplace plans are divided into several metal tiers to help consumers find a balance between low premiums and adequate coverage. These tiers vary based on the deductibles, out-of-pocket maxes and other features that each plan offers.

The table below shows plans with the lowest monthly premiums in each metal tier. These are sample rates for a 40-year-old man, but these prices may vary depending on your specific needs. In addition, low-income shoppers can benefit from seeing if they are eligible for cost-sharing reductions (CSRs), which can lower their premiums even more.

Coverage

In Texas, there are a variety of ways to get health insurance. You can either buy it from your employer or get it through government-assisted programs like Medicare (if you are 65 or older) and Medicaid.

If you qualify, these programs can provide coverage for you and your family free of charge. Often, these programs also help you save on premiums.

The cheapest coverage option for some Texans is Medicaid. It’s free and covers hospital stays, medical care and some home health services.

However, you’ll need to meet certain income and family qualifications to qualify.

Alternatively, you could look for private healthcare coverage in the Texas insurance exchange. These plans vary in cost based on your age and other factors, but can be more affordable than government-assisted options.

Whether you choose to use Medicare or Medicaid, it’s important to understand your plan’s benefits and how much you’ll pay for certain treatments and services. Check out your Summary of Benefits and Coverage document for details.

Access

You can buy private health insurance in Texas through a variety of options. These include Affordable Care Act (ACA) plans, short-term health insurance, and Medicare Advantage and Medicare Supplement coverage.

The costs for these plans vary, based on the metal tier you choose and your age. For instance, a 26-year-old purchasing a Silver plan pays an average monthly premium of $396.

However, you’ll pay more in out-of-pocket expenses if your medical costs are high. This is because cheaper tier plans tend to have higher deductibles and out-of-pocket maximums.

Fortunately, Texas has a marketplace where you can compare plans to find the one that suits your needs and budget. This marketplace is known as the Texas insurance exchange.

Healthcare plans in the Texas insurance exchange are broken down into different metal tiers, each with their own premiums, deductibles and out-of-pocket maxes. Generally, Catastrophic and Bronze plans have the lowest premiums but the highest out-of-pocket costs. Gold and Platinum plans have higher monthly premiums but lower out-of-pocket costs.

Convenience

Texas Health Plans offers a comprehensive suite of benefits and services. Some of the more notable benefits include a wide network of doctors and hospitals; free or low-cost walk-in, urgent care and virtual health visits; $0 co-pays on many prescription drugs; access to thousands of pharmacies; and more.

The state of Texas offers a unique insurance marketplace for individuals and families who don’t have coverage through their employer or a government program like Medicaid or Medicare. While the marketplace doesn’t have all of the same options, it does offer a robust collection of health plans with some of the lowest monthly premiums around.

Choosing the best plan for you and your family is no easy task, but there are plenty of high-end, high-tech and well-designed health insurance solutions to choose from. From the Texas Health Medico-Memorial to Medicare Advantage and standalone PDPs, we’re confident you’ll find something that suits your needs. Our team can answer your questions and help you navigate the health insurance maze.