There are numerous health insurance carriers offering individual policies in Texas.
Texas probably has one of the largest selections of carriers doing business due to the state's large population base.
There are many different types of individual plans to choose from.
(1) Major medical - typically a deductible and coinsurance type plan in exchange for reduced premiums.
(2) Preferred Provider Organization Plans (PPO’s) - offering premium savings for agreeing to use a specific network of providers who have pre-agreed to a pricing schedule for their services. Many PPO products are a major medical type product with the enhancement of copays for doctor visits and copays for prescription drugs, etc.
(3) Health Maintenance Organization (HMO) - not a fee for service type of coverage. In general, HMO’s collect premium and disperse the premium to its provider members monthly whether you visit a provider as a patient or not. This is the reason that HMO’s often keep you assigned to a specified provider or provider facility.
(4) Health Savings Accounts (HSA’s) - a two product concept that combines a high deductible major medical type of plan at reduced costs and a tax deductible account (similar to an IRA).
The insured / account holder may contribute dollars to his tax deductible Health Savings Account and withdraw from it to pay eligible medical expenses without penalty. What makes the HSA a great product is: (1) the list of eligible expenses allowing withdrawal of funds, far exceed the covered items of most insurance plans. An example: eyeglasses, contact lenses, dental treatment, braces, dentures, birth control pills, vitamins (if prescribed), hearing aides and the list goes on and on (with pretax dollars - are you seeing the value here???!!!). (2) You own your Health Savings Account - at age 65, your unused portion of your HSA has the potential to provide a healthy retirement supplement.
As a general product overview:
(1) Major Medical plans typically offer the most flexible provider choices while leaving you more upfront out-of-pocket costs in the form of deductibles and coinsurance.
(2) PPO’s typically offer greater premium savings combined with flexible provider choices but also typically impose penalties when leaving the provider network.
(3) HMO’s typically provide the lowest out-of-pocket costs for routine care such as: office visits, routine exams, prescription drugs, maternity benefits etc., however they also tend to be more expensive and much more restrictive when offering referrals or allowing non-network services and non-network specialty providers. (if at all).
There are now many variations of the above mentioned products available to the potential insurance buyer.
Major medical that offer copays, PPO’s that impose huge out-of-network penalties, and HMO’s offering deductible type plans. For these reasons it is very important to have a full time health insurance professional assist you, to define your individual health insurance needs against the affordability of premiums to be paid.
When a resident of the state of Texas makes application for an individual health insurance policy.
The insurer may issue the policy: (1) standard as applied for, (2) issue with a rate-up of premium, (3) issue with a rider(s) - excluding specific pre-existing condition(s), (4) issue with a rate-up and rider(s), or (5) decline a person for coverage, based on prior medical history.
Texas Health Insurance Risk Pool
