Emuparadise

Texas offers many affordable health insurance options. The types of plans available vary by county. Some plan types, such as HMOs and EPOs, restrict you to using in-network providers. Some require a referral from your primary care provider to see specialists.

Each plan option has a different monthly premium and deductible. Each one also works with a health savings account.

Costs

There are many factors that influence the cost of Texas health insurance. Some of these factors include the type of plan you choose and your income. In addition, some people may qualify for subsidies to reduce the cost of their monthly premium. This can be beneficial for Texans who earn below the poverty level.

In the Texas private marketplace, plans are grouped into metal tiers. These tiers determine the maximum out-of-pocket costs, deductibles, and coinsurance you’ll be responsible for. Each tier has a different monthly premium and deductibles. The lowest-cost options are Catastrophic and Bronze plans, which are best for those who don’t expect to visit the doctor often.

You can also choose a Silver or Gold plan, which offer more coverage with higher monthly premiums. These plans are popular among people with low-incomes, as they offer lower deductibles and coinsurance payments. However, these plans have a higher price tag than Catastrophic and Bronze plans.

Coverage

Most Texas residents have health insurance coverage through their jobs, the private market, Medicare, or the Children’s Health Insurance Program. However, those without insurance face a more challenging path to affordable care. They are more likely to seek health care in expensive settings, such as the emergency room, and may experience worse health outcomes than those who have insurance coverage.

Benefits eligible employees can choose from a variety of medical plan options that meet their individual needs and budget. The plan options work differently, and it is important to understand how each option works before choosing the right one for your family.

In Texas, there are limits on how much premiums you can be charged based on your health status. In addition, if you lose your group insurance because of a change in employment, you can buy an individual policy through the Texas Health Insurance Pool. If you’re HIPAA eligible, you can’t be denied or charged more than others for a pool policy.

Pre-existing conditions

The Affordable Care Act, or Obamacare, prohibits private health insurance companies from denying coverage to individuals with pre-existing conditions. This rule applies to people with individual, group, and Medicare plans. However, the law does not limit how much a company can charge for an individual policy or how long they can exclude coverage for a particular pre-existing condition.

The majority of Texans support these protections. In a recent statewide EHF survey, 9 in 10 Texans said they believe that state government should play a role in making sure the insurance market works for everyone.

Texas should place reasonable limits on “short-term” plans, as 23 other states have done, to ensure that they are available to fill gaps in coverage and mitigate big premium hikes for those with pre-existing conditions. It should also guarantee access to individual health insurance for people who lose their group coverage and meet other requirements by creating a high-risk pool. Currently, only those who are HIPAA eligible can buy Texas individual health insurance.

Medicaid

Millions of Texas residents depend on Medicaid, the federal-state health insurance program for low-income families and individuals. The program covers prescription drugs and other medical costs, such as X-rays, lab tests and surgeries. In addition, Medicaid provides help paying Medicare premiums and covering costs not covered by Medicare — such as long-term care.

The program keeps Texans healthy and active, while saving taxpayer dollars. Today, more than 5.5 million Texans rely on Medicaid for the healthcare they need.

However, as of April 1, the state will begin a mandatory review of its 5.9 million-member Medicaid caseload. If current recipients fail to complete the paperwork, they could lose their coverage. This could affect children who rely on Medicaid for prescription refills and parents who rely on the program to get their children back-to-school vaccinations. In contrast, private insurers are allowed to turn down people with pre-existing conditions or charge them more for coverage. In the Texas marketplace, low to moderate-income residents can receive financial assistance benefits that reduce the cost of their insurance based on household income.