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Frequently Asked Questions for Texas Individual Health Insurance

 

  • What is Individual and Family Health Insurance?
  • How can I find the cheapest rates?
  • Which health plan is right for me?
  • How can I estimate how much I'll spend on health care?
  • Why is Individual Health Insurance so expensive?  
  • What is an annual deductible?
  • What is a PPO?
  • What is an HMO?
  • What is COBRA?
  • How is Texas Individual Health Insurance different from other states?
  • What is Short-Term coverage?
  • What is an HSA?
  • What are high deductible health plans?
  • What are "Saver" Plans?
  • What is coinsurance?
  • What is the "total out of pocket maximum"?
  • How long does it take to get approved?
  • What is an exclusion?

 

Q: What is Individual and Family Health Insurance?
A: This is non-Group insurance or insurance that you cannot get through an employer.
Q: How can I find who has the cheapest rates?
A: The insurance companies set the rates.  The best way to compare rates is through an Independent Insurance Broker/Agent, who can price several plans, based on your needs.  There is no charge for this service, because the insurance carriers pay the broker/agent when there is a sale.
Q: Which health plan is right for me?
A: If you’re seeking comprehensive coverage that will pay for routine medical expenses, you want a comprehensive major medical plan.  If you want to partner a tax-friendly health savings account with your major medical coverage, you want an HSA.  If you’re willing to pay for smaller expenses, such as doctor office visits and prescription drugs, in exchange for protection against a large medical expense, you want a high deductible or "saver" plan.  If you are in transition or between jobs, you want a short-term plan.

Q: How can I estimate how much I'll spend on health care?
Q: Why is Individual Health Insurance so expensive?
A: With Group Plans, companies are only required to pay at least 50% of an employee’s premiums.
Q: What is a PPO?
A: The Preferred Provider Organization is a network or doctors with which the insurance companies have negotiated discounted pricing for medical services.  These rates are 20% to 40% less than out of network doctors and are independent of any deductible. 
A: A Health Savings Account offers affordable health insurance, triple tax savings, and greater control over health care expenses.  For more information, see HSA Center.
Q: What are high deductible health plans?
A: These are health plans with high deductibles. 
Q: What are "Saver" Plans?
A: These plans usually offer a limited number of doctor visits, with a copay.
Q: What is coinsurance?
A: This is the amount over the deductible that the insured is obligated to pay.  If the negotiated bill is $10,000, the Deductible is $2500, and the coinsurance is 20%, the insured pays a total of $4,000.
Q: What is the "total out of pocket maximum"?
A: This is the entire amount you would be obligated to pay.  That is the deductible, plus the coinsurance.  If it is a family plan, the plan may indicate a multiple, usually two or three persons, times the deductible.