The State of Texas is home to three of the top ten most populous cities in the U.S., including Austin, the live music capital of the world. While it brings to mind pick-up trucks, cowboy hats and border patrol, it also is a center of technology, professional sports, and influential in the U.S. government. Texas residents have the benefit of great American health insurance companies such as Aetna, Blue Cross Blue Shield, Cigna, Humana and UnitedHealth to provide them with coverage. Plans through these insurers come in a variety of types, and it is essential to compare rates between them to see what fits you best. Enter your zip code below to find out what plans are available in your area.
Health could be a greater point of concern in Texas, as the overall health of the state has steadily declined over the past six years. According to the UnitedHealth Foundation, there is a high occurrence of infectious disease, as well as an increase in the number of obese adults, which is currently 5.8 million, or 31.7% of the total population. Diabetes is also very prevalent in Texan adults, also seeing an increase in the past ten years. Despite its shortcomings, the amount of smokers is on a decline in the state, and there is a low frequency of cancer-related deaths.
Texas also has a large population of uninsured individuals, reaching 6.2 million as of 2010. As the health status of the the state is decreasing, Texan residents need to take advantage of the opportunities to be healthy around them. Sure, it is a land of everything large, food included, that is no excuse for millions of people neglecting to maintain an acceptable level of healthiness. Regardless of being able to afford insurance, there are lifestyle changes that can be made (Texas has plenty of nature trails!) and public health programs to utilize if the task of being healthy is too daunting to accomplish on your own. Insurance companies and the Health Department both provide access to wellness and fitness programs, and nutritional information.
Health Insurance Plans
- Open Access Managed Choice PPO plans give you access to Aetna’s PPO network for a selection of deductibles. These plans offer the choice of using in-network providers for a discounted rate, or seeing out-of-network providers for about twice as much. In-network doctor and specialist office visits are available for a copay before you meet your deductible, and preventive care is covered in full. Many other services are available once you have met your deductible for coverage at 80%.
- Open Access Managed Choice Value plans are PPOs with the ability to see in or out-of-network providers. These plans have a copay for services such as doctor’s office visits, urgent care, and prescription medications. After your deductible has been met, a variety of medical services will be available for a small percentage of coinsurance.
- Open Access Managed Choice Preventive & Hospital Care plans are basic PPO plans that offer preventive care at 100% from the start date of your plan, as well as coverage on hospital care after deductible such as surgical procedures, inpatient services and home health care. These plans are also compatible with health savings accounts, which enable personal finance management in terms of your health care. You can choose to save your HSA funds for retirement, or use them to meet deductibles or pay coinsurance on certain medical services.
- Open Access Managed ChoiceHigh Deductible(HSA Compatible) plans come in a variety of deductibles and provide comprehensive coverage on many services after your deductible has been met. These are also eligible for pairing with an HSA, the funds from which can help you meet your high deductible sooner, or can be saved for tax-deductible and tax-free future growth. Prescription coverage, doctor’s office visits, inpatient hospital services and emergency care are some of the medical services you will have covered after deductible.
Blue Cross Blue Shield of Texas
- PPO Select Saver plans are high annual deductible, low monthly premium plans that give you access to the BCBSTX PPO network near you, as well as care outside of the network. These plans have an unlimited lifetime maximum, as well as 100% coverage for preventive care immediately when your plan becomes effective. Prescription drugs are available for a copay, and various hospital services are covered at a certain percentage before deductible. Saver plans are convenient, and do not require meeting a deductible before receiving coverage on emergency and urgent care, or outpatient surgery.
- PPO Select Choice plans are similar to the Saver plan listed above, but with more coverage options and a wide variety of deductibles – from $250 – $10,000 for an individual in-network, and $750 – $30,000 for families in-network. Members of this plan also pay an in-network copay of $25 for physician office visits. Preventive care includes child immunizations, routine physicals, routine lab work, and colorectal, prostate, cervical, and breast cancer screening, all of which is covered at 100%.
- BlueEdge Individual HSA plans are high deductible plans with health savings account capabilities. These plans offer coverage on major medical, hospital and surgical expenses, and give you the option of choosing in or out of network care. With a range of deductibles to choose from, your plan will cover various services after having met your deductible amount. Yearly physical exams, check-ups, and care for women’s health are all covered at 100% in or out of network before deductible. Save your tax-advantaged HSA funds for the future, or put them towards specified health care services, it is up to you.
- Select Blue Advantage plans are PPOs with prescription coverage and doctor’s office visits for a predictable copay. Blue Advantage plans cover necessary hospital and emergency services at a certain percentage of coinsurance before meeting your deductible, so you can have access to care at any time. Preventive services are available at no cost to you from the day your plan starts.
- Open Access plans are available in two types: Value and PPO. Both are PPO plans, with the freedom to select providers from Cigna’s preferred network or an out-of-network provider for a higher rate. Some of these plans are offered with dental coverage, and there are a variety of deductible and coinsurance types to choose from. Depending on the amount of coverage you select, Cigna will cover 70 (Value plans), 80 or 100% of your hospital and medical expenses after you meet your deductible. Members will not be charged for preventive care services such as yearly physical exams and immunizations.
- Health Savings plans are high deductible plans that are compatible with a health saving account (HSA). Plans such as these are best utilized for future planning, and having a safety net of options in case of injury or illness. In-network preventive, inpatient, outpatient, physician, emergency, and mental health care and home delivery pharmacy are all covered at 100% before deductible. With your HSA, you can save for retirement or use funds to pay for qualified medical costs.
- Value plans connect its members to HumanaOne’s Preferred network for discounted services, and also the freedom to seek out-of-network care. These plans have high deductibles, prescription discounts and preventive care covered in full. After your deductible has been met, Value plans cover in-network physicians visits, X-ray and lab work, inpatient hospital and mental health care, among other services at 100%.
- Copay plans are also PPO plans, with the option of using the Preferred network of providers or out-of-network providers for medical care. These plans help simplify the health care payment process by offering a flat rate for specified services, such as doctor’s office visits and prescription drugs. Once you have met your deductible, most other services such as hospitalization are covered at either 70 or 80%, depending which you choose. Some Enhanced Copay plans are qualified for use with an HSA, and others have a dental benefit option.
- HSA plans from HumanaOne have high deductibles and are eligible for use with a health savings account. After you have met your deductible, HSA plans cover emergency, lab tests, physician’s office visits, inpatient, outpatient, and outpatient mental health care. A comprehensive level of care is offered through these plans, with a great level of protection for you and your family in case of unexpected circumstances. The HSA capability is also a plus, in that you can deduct it from your income taxes and use the HSA funds for various medical expenses.
- High Deductible plans are PPOs available with a range of deductibles and types. You can choose either a Saver 80, Plan 80 or Plan 100, all of which have preventive care covered in full before deductible. After deductible, your plan will either cover 80 or 100% of your major medical costs depending on which one you select. Saver plans have the lowest premiums, Plan 80 is the overall most affordable – balancing deductible and premium costs, and Plan 100 is the most easy to use.
- Copay plans also give access to the UnitedHealthOne PPO network near you in Texas, and are available in several deductible amounts. Doctor’s office visits and prescription drugs are available for a copay before you have met your deductible, and once you have, most other in-network services are available for a set level of coinsurance based upon your specific plan. Preventive care is also covered at 100% before you meet your deductible.
- HSA plans have a high deductible and the ability to be linked with a health savings account (HSA) for tax-advantaged funds that can be used exclusively in a medical context. These plans are available with either 70 or 100% coverage after you have met your deductible on most services through an in-network provider. Such services include surgeries, emergency room care, hospitalization, office visits, a Preferred Price Card for prescriptions, and inpatient hospital care.
Public Health Options
In the State of Texas, there are a variety of services and programs that may be utilized by those in need. For many major illnesses, there are a public assistance programs funded by the state. Texas provides health care coverage through Medicaid to low-income families, children, pregnant women, disabled, blind and elderly individuals. The state also offers more specified services for conditions such as breast and cervical cancer, epilepsy, osteoporosis, and genetics disorders to name few. For a complete list of all programs and services, visit the Texas Health and Human Services Commission site.
- Medicaid & CHIP: health care coverage for children and families who meet Federal Poverty Level criteria, or have a disability, are blind, pregnant or aged.
- Women’s Health Program (WHP): family planning, contraception, and GYN services for low-income women who qualify for Medicaid in Texas
- Refugee Medical Assistance Program: medical assistance for individuals who are living in Texas and cannot return to their country of origin
- Texas Nurse-Family Partnership: provides low-income first-time mothers with help from registered nurses for prenatal care and continuing assistance through the child’s second year
Health Insurance Laws
In Texas, despite a variety of state-funded programs, there are not many laws that work in favor of the insured individual. Many services, such as mental health care coverage, are not mandatory to be covered by health insurance. Also, pre-existing conditions can be permanently excluded with the attachment of an elimination rider, or issued an exclusion period of one year. Insurers in Texas define pre-existing conditions through a prudent person standard, which means they consider health problems that the applicant both received care for and could have received care for in the past. This is a fairly broad definition, leaving room for the insurance companies to make their own rules in many cases.
Texas does, however, have a high-risk pool offering health insurance to those rejected by insurance companies for a policy. The Pre-Existing Condition Plan gives affordable coverage to those who have been told by an insurer that they have a pre-existing condition and will not be accepted for a private market plan. If this has occurred in your experience with health insurance companies, or you feel a condition you have may qualify you for the high-risk pool, compare rates by filling out a quote and selecting PCIP under companies.
The Affordable Care Act will eliminate the need for high-risk pools in 2014, as all adults with pre-existing conditions will not be legally allowed to be rejected for a health plan by a private insurance company. This important piece of the ACA will also rid the individual market of elimination riders and exclusion periods, therefore requiring insurers to cover expenses related to treating a policy-holder’s pre-existing condition.
One up side of health insurance laws throughout the country is HIPAA. Under this law, those who have insurance are protected by the guaranteed renewability provision, which states an insurer cannot cancel a client’s benefits due to acquiring an illness during the time they have been paying for their plan. Guaranteed renewability also secures the same plan for an insured individual, as insurers must give the option of renewing the same plan at term’s end. HIPAA also protects the medical information transferred electronically during any health care transaction made by an individual.