Answers to 5 Common Questions About Texas Health Insurance

2010-02-23T21:39:00.000-08:00

Although Texas ranks the highest among U.S. states in the number of uninsured residents, obtaining affordable Texas medical insurance is easier and more affordable than you think. Here are answers to five common questions about getting health insurance in Texas.

1. I'm young and healthy. Why should I spend money for medical insurance that I'll never use?

Having insurance is like carrying an umbrella. You may not need it most of the time, but when there's a torrential downpour you'll be glad you have it. Even young and healthy people have accidents, seasonal illnesses, and sometimes tragic health issues. If you wind up having a serious medical condition, it can become very difficult to obtain Texas medical insurance, or your preexisting condition may be excluded from your coverage. In addition, you can get much lower premiums when you're young and healthy, so health insurance provides excellent protection at very little cost.

2. Is there a benefit to using a health insurance agency, as opposed to getting quotes for policies on my own or going through a single agent?

A health insurance agency provides a number of benefits. First, they have established relationships with many, many insurance companies. This means that they have access to all of the best Texas medical insurance plans in the marketplace, while not having a bias toward any single insurer. This is in contrast to some individual agents, who work on behalf of one or two companies, and who will try and push you to sign up with their company. While you can research various plans on your own, a health insurance agency will do the legwork for you and present you will all available options, at no charge to you.

3. What's the most important feature to consider when buying health insurance?

There are two important features that people often overlook: the lifetime maximum coverage and the maximum out-of-pocket expense. Although your more immediate concerns might be co-payments for doctors' visits and prescription coverage, if you or a family member experiences a catastrophic illness, your overall coverage and out-of-pocket costs are much more crucial. Look for a policy that offers lifetime maximum coverage of $3 million or more, and a yearly out-of-pocket maximum in the $2,000 to $3,000 range.

4. Can I trust online comparisons for Texas health insurance?

Yes. The law requires that identical plans have identical pricing, regardless of whether you go directly through the insurer or use a health insurance agency. In other words, if you're looking at the XYZ company's Plan A, you will receive the same quote whether you get it online, place a phone call, or visit an insurance agency or company. Keep in mind though, that the price you pay may depend upon a number of variables, including your age, your gender, whether or not you smoke, and any pre-existing medical conditions that you may have. The final price is in large part determined by your medical history.

5. What's the difference between an HMO and a PPO?

When it comes to Texas medical insurance, a health maintenance organization (HMO) requires that, for non-emergency services, you use their physicians and hospitals. A preferred provider organization (PPO) allows you to visit any health care provider, but gives you more benefits if you use health care professionals and services within their network.

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5 Basic Facts About Health Insurance Policies In A Bad Economy

2010-02-23T21:35:00.000-08:00

1. DOES YOUR PLAN COVER YOU ON AND OFF THE JOB?

Many health insurance plans have specific exclusions that eliminate your benefits for anything that could have been covered under Workers Compensation or similar laws. Now read that last sentence again.

COULD HAVE BEEN COVERED!?

That is correct. Most self employed people and even some small business owners do not carry Workers Comp on themselves.

There are designed insurance plans that will cover you on and off the job — 24-hours a day, if you are not required by law to have Workers Compensation coverage.

2. ARE YOU WRITING IT OFF?

Independent contractors (1099's), home based business owners, professionals and other self employed people generally are not taking advantages of the tax laws available to them.

Many people who are paying 100% of their own costs are eligible to deduct their monthly insurance payments. Just that alone can reduce your net out-of-pocket costs of a proper plan by as much as 40%. Ask your accounting professional if you are eligible and/or check out the IRS website for more information.

3. INTERNAL LIMITS
All true insurance plans use some form of internal controls to determine how much they will pay out for a particular procedure or service. There are two basic methods.

-Scheduled Benefits

Many plans, some of which are specifically marketed to self employed and independent people, have a clear schedule of what they will pay per doctor office visit, hospital stay, or even limits on what they will pay for testing per 24-hr. period. This structure is usually associated with "Indemnity Plans". If you are presented with one of these plans, be sure to see the schedule of benefits, in writing. It is important that you understand these type of limits up front because once you reach them the company will not pay anything over that amount.

-Usual and Customary

"Usual and Customary" refers to the rate of pay out for a doctor office visit, procedure or hospital stay that is based on what the majority of physicians and facilities charge for that particular service in that particular geographical or comparable area. "Usual and Customary" charges represent the highest level of coverage on most major medical plans.

4.YOU HAVE THE ABILITY TO SHOP!

If you are reading this you, are probably shopping for a health plan. Every day people shop, for everything from groceries to a new home. During the shopping process, generally, the value, price, personal needs and general marketplace gets evaluated by the buyer. With this in mind, it is very disconcerting that most people never ask what a test, procedure or even doctor visit will cost. In this ever-changing health insurance market, it will become increasingly important for these questions to be asked of our medical professionals. Asking price will help you get the most out of your plan and reduce your out-of-pocket expenses.

5. NETWORKS AND DISCOUNTS

Almost all insurance plans and benefit programs work with medical networks to access discounted rates. In broad strokes, networks consist of medical professionals and facilities who agree, by contract, to charge discounted rates for services rendered. In many cases the network is one of the defining attributes of your program. Discounts can vary from 10% to 60% or more. Medical network discounts vary, but to ensure you minimize your out-of-pocket expenses, it is imperative that you preview the network's list of physicians and facilities before committing. This is not only to ensure that your local doctors and hospitals are in the network, but also to see what your options would be if you were to need a specialist.

Ask your agent what network you are in, ask if it is local or national and then determine if it meets your own individual needs.

full coverage health insurance | affordable comprehensive health insurance coverage