Texas Health Insurance Information
The majority of U.S. citizens who have health coverage (around 57%) get coverage through an employer-sponsored plan. An additional 29 % get coverage via a government sponsored plan - Medicaid, Medicare or the military. If you're self-employed, or if your employer does not provide health insurance, you'll likely turn to the private market to buy an individual health insurance plan.
Chances are, if you came to our website, it's because you're hunting for affordably priced individual health insurance.
Acquiring individual coverage is usually much more challenging than qualifying for than a group plan provided by an employer; policies are individually underwritten, which means that the insurance business will closely scrutinize your complete medical history.
Health insurance organizations are for-profit entities. When they agree to insure you, they're betting that you'll pay more into the organization in the form of premiums than they'll pay out for your medical claims. Therefore, when you already have a medical condition, they may well refuse to insure you - or they may put a rider on your policy which will not pay for that pre-existing condition. That's why the best time to apply for insurance is prior to you have medical complications.
Group plans are regularly written so that you can still qualify even should you have a pre-existing condition - that's due to the fact the risk is spread across all the paying members of your group. In very modest groups, a serious illness can cause the insurance corporation to dramatically raise premiums for all the members of that group.
It's Better To Be Truthful And Upfront
Whenever you apply for coverage, be certain to disclose any medical complications you've had, no matter how insignificant you perceive the issues to be. If you don't, you may fall victim to a controversial insurance industry practice called rescission. If you've been a victim of rescission, your insurance company has received a claim from you, and then - after reviewing your application and medical history for undisclosed conditions or inconsistencies - has cancelled your policy at a point when you needed it most.
So if an agent tries to "help" you by omitting any of your health history, they aren't really helping you. They are just attempting to close the sale. Buyer beware.
Buy Insurance For What You Need – But Do Buy
It sounds dire, but it's vital that you've got health insurance for you and your family. Extra than 60 percent of bankruptcies in the United States are the result of medical bills. Sadly, if you're self-employed, you might be 1 major illness away from bankruptcy or losing your business.
Additionally, over a recent six-year period, an estimated 137,000 Americans died on account of a lack of health insurance. They either received too small care or received that care too late.
Unable To Acquire Private Health Insurance?
The Texas Health Insurance Risk Pool is for people who have been denied coverage by private insurance providers. These plans are robust and supply an inexpensive - albeit higher-than-average-price - alternative. The Texas Health Insurance Risk Pool is administered by Blue Cross Blue Shield. You can check out their site www.txhealthpool.org to see if this choice is readily available to you.
Major Changes to Texas Health Insurance due to Healthcare Reform
As a result of Patient Protection and Affordable Care Act (PPACA) the following benefits were added to most all individual Texas Health Insurance plans with effective dates of September 23, 2010 or later:
Preventive care coverage: For adults with most individual Texas health insurance carriers these benefits are now covered as a first dollar expense by the carrier. This means that with most plans you have no deductible, coinsurance, copays, or waiting periods for adult preventive care coverage(for in network care). Prior to healthcare reform most Texas health insurance carriers had limits around $300 to $500 per covered adult.
No Aggregate lifetime dollar maximum: Most Individual Texas health insurance carriers have done away with the limitations to the lifetime maximum coverage per person. For example, before Texas health insurance reform most carriers had either a $3 or $5 million lifetime maximum per person. After reform, most Texas health insurance plans have an unlimited lifetime maximum per person while covered under that plan.
Prescription Drugs: Most Texas health insurance carriers have done away with any annual dollar limit for prescriptions. Prior to healthcare reform most carriers had $3000 to $5000 annual limits per person.
Children with Preexisting conditions: children under age 19 will have no preexisting condition exclusions. This is required on a state-by-state basis, that dependent children under the age of 19 will not be declined based on medical history. Prior to healthcare reform most Texas health insurance plans could decline a child with a preexisting condition and forcing them to take coverage through the Texas Health Insurance Risk Pool.
Dependent Children: dependent children will be allowed to stay on their parent/legal guardian plan until age 26
5 steps to choosing the Right Texas Health Insurance Policy
1. The first thing to consider is what you want the plan to do for you. There are really two types of individual Texas health insurance plans: traditional and non-traditional. Traditional plans are going to include office and prescription copays and have a major medical deductible for your large expenses. Non-traditional plans are will have a higher deductible that you pay out of pocket until you reach your deductible and then most plans pay at 100%.
2. You should look at how much your deductible you are comfortable to pay each year. The deductible is the amount that you have to pay out of pocket before your insurance will start paying for part of the cost. The non-traditional plans mentioned about will have you pay the deductible before they will cover office visits. The traditional insurance plans require a copay for office visits and do not count that amount towards the deductible.
3. The next thing you should consider is how much your copays and coinsurance are. Your copay is the up front cost you pay to go to a doctor, a specialist or the emergency room—You will see that most Texas health insurance plans have copays ranging from $15 to $45 per visit. Your coinsurance is the amount of each bill you are responsible for after the insurance pays its part. The most common coinsurance amount is 80/20. For example, the insurance will pay eighty percent of the costs, and you will pay twenty percent of the costs once you have met your deductible. Several non-traditional high deductible plans also have 100% coinrurance—with these 100% plans the insurance company will cover 100% of the costs once you have met your deductible.
4. Next consider the out-of pocket maximums that each plan has listed. Once you reach this limit your insurance will cover everything else (except for copayments on traditional plans). For example, if your plan had a $1000 deductible and 80/20 coinsurance to the next $1500, your out of pocket maximum on this plan would be $2500.
5. Finally add up how much you will end up paying from each plan if the worse thing were to happen to you. In addition add in the cost of insurance to yourself for each plan. If you have poor health, you will want to choose the plan that will cost you the least amount out of pocket for the entire year. If you are in relatively good health you may choose to go with the plan with the lowest premiums or you may decide to go with the middle. Today many Texas health insurance customers are purchasing non-traditional high deductible health insurance plans because these high deductible plans usually have a lower premium, but you are responsible to pay for everything until you meet your deductible. The deductible can be anywhere from $1500.00 to $5000 per individual per year and $5000.00 to $15000.00 per family per year. Always make sure that when choosing your deductible that in the worst case scenario you have enough money to cover the deductible each year.
5 Options of any Texas Health Insurance Policy
1. Plan Type: Choose a specific insurance plan type from the available set of plan types. If a certain plan type does not appear, this means currently that plan is not offered. By default, health plans of all types will be displayed.
Here is the definition of each plan type:
• HMO (Health Maintenance Organization) Prepaid health plans in which you pay a monthly premium and the HMO covers your cost of care to see doctors within their network at pre-negotiated rates. You must choose a primary care physician who coordinates all of your care and makes referrals to any specialists you might need. If you are an HMO member and you do not use the doctors, hospitals and clinics that participate in your plan's network, you will usually bear the cost of those medical services
• Indemnity Traditional health insurance that usually covers a percentage of the cost of care (often 80%) after the consumer pays a deductible. Insureds with indemnity coverage can choose any doctor or hospital for their care.
• HSA (Health Savings Account) A tax-advantaged personal savings account used in conjunction with a high deductible health policy. Individuals can contribute money to this account on a pre-tax basis to set aside money for qualified medical care and expenses, including annual deductibles and copayments.
• POS (Point-of-Service) A type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). You can decide whether to go to a network provider and pay a flat dollar or to an out-of-network provider and pay a deductible and/or a coinsurance charge.
• PPO (Preferred Provider Organization) A network of health care providers that have agreed to provide medical services to a health plan's members at negotiated costs. PPO members typically make their own decisions about their health care rather than going through a primary care physician like HMO member. The cost to use physicians within the PPO network tends to be less than using a non-network provider.
2. Deductible: A deductible is the amount of money paid by the insured each year to cover eligible medical care expenses before the insurance policy starts paying. Deductibles shown are for network when applicable. Select higher amounts to lower monthly premiums.
3. Coinsurance: Coinsurance is the amount shared by the insured and insurer for eligible medical care in a fee-for-service plan, an indemnity plan or a preferred provider organization (PPO) after the deductible has been met. It is usually expressed as a percentage of eligible charges. For example, if the insurance company pays 80 percent of the claim, the insured pays 20 percent.
4. Copays: Co-pay is a specific amount an insured pays for a specific medical service. For example, the insured may pay $35 for an office visit or $15 for a prescription and the health plan may cover the rest of the eligible charges. Select a higher amount to reduce monthly premiums.
5. Premium: The monthly premium is the amount paid each month in exchange for health insurance coverage. Typically, if a person pays more in monthly premiums they will pay less for routine doctor visits and other services. Note: The estimated monthly premium may change based on medical history, the underwriting practices of the health plan, occupation (where allowed), or other factors as determined by the health insurance company.
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