Health insurance remains an issue of utmost concern since it is concerned with the well-being of a person in a very direct manner therefore it is important to have it but how can one have it affordable and that too in Texas remains to be probed into.
In today’s age and time, health insurance has become a necessity as now it is no longer something that should be treated as some kind of luxurious undertaking.
With it being propelled to a position of greater significance in almost every single US state then there comes a matter to ponder about and that is over the price and impact of such a scheme.
Now one mulls over the extent as well as the veracity to which health insurance can benefit them despite everything that they do undergo in life therefore it remains a highly poignant topic to cover. This article endeavors to touch upon the reality and manifold possibilities which lie behind the availability of genuine health insurance in the largest state of the USA known to the world by the name of Texas.
The article gives you an insight for the very first time into the affordability of an insurance program of this kind and that too within the largest state with the largest of ( greater magnitude) of problems in the USA.
For everyone regardless of them being rich, super-rich, poor, middle class, or extremely poor there should be a safety net for your health, and that only comes from the provision of a service as valuable as that of affordable health insurance and that too in your state implying you don’t have to travel long distances to go fetch your prized possession that will always remain your health insurance but only the one that is affordable out of all.
So what is affordable health insurance in Texas?. Let us find out in detail.
Table of Contents
- 1 What is health insurance?
- 2 Best health insurance in Texas:
- 3 Types of health coverage in Texas
- 3.1 Health Maintenance Organization (HMO)
- 3.2 Preferred Supplier Organization (PPO)
- 3.3 PPO astonishing facts:
- 3.4 Service point plan (POS)
- 3.5 What does health insurance cover?
- 3.6 Best health insurance in Texas – 10 essential benefits.
- 3.7 Other essential health insurance benefits in Texas
- 3.8 Additional for women
- 3.9 What’s not covered by health insurance?
- 3.10 Contact your insurer
- 3.11 Scott & White health plan
- 3.12 Aetna
- 3.13 Community First health plans
- 4 Conclusion
What is health insurance?
The Health Insurance Listen is a device to insure an individual facing financial risks of care in case of illness, as well as a minimum income when the condition deprives the person of work.
In most Western countries, a large part of health insurance is covered by the state. It is also one of the fundamental components of social security, and a duty of the State according to the Universal Declaration of Human Rights of 1948.
A public health insurance system may be managed by a State body, delegated to private bodies or be mixed.
The operation, like all other insurances, is based on the mutualisation of the risk: each person contributes, and in exchange, he is reimbursed according to a fixed scale.
For a public health insurance system, the insurance premium paid by the insured does not necessarily follow the rules of pure insurance, and it may not be based on risk alone. In fact, the public system fulfils both a pure insurance function and a distribution function in which the wealthiest pay the insurance of the most disadvantaged.
Until the 18th century, protection against the risks of life was ensured by personal wealth, local (family, village) or professional (guilds, jurandes) solidarity and charity.
Health insurance models
Health insurance can take two different forms:
either it is simply a financial insurance: the individual is insured for a risk (accident, illness), and his care (remuneration of practitioners, cost of products and drugs, prostheses, orthotics, etc.) are reimbursed according to the scale;
either the insurer constitutes a care network: it contacts practitioners and providers. Insurance buys a kind of subscription to this care network and resells it to the user; in its most extreme form, the insured does not have the choice of his practitioner, at least if he wants to benefit from the free treatment or their reimbursement. We can have a coexistence of these two models.
Private, public or mixed system
Health insurance can be a purely state (public) body, which can be only private insurers or you can have a mixed system: the user has public insurance and can take out private insurance with a company or mutual insurance company (called “complementary health” in France), which supplements the reimbursement or provides access to a network of complementary care.
It can be seen that the countries which have adopted a purely private and competitive system are also those for which expenditure is highest. For example, while developed countries spend on average 10% of their GDP on their healthcare system, the United States spends 14% and Switzerland 13%.
Competitive insurance system
Nevertheless, in a competitive insurance system, insured persons choose the level of expenditure they want in relation to the level of health coverage they want.
The level of expenditure in a competitive system therefore indicates the level of expenditure desired by consumers. In a public system, the State sets the level of expenditure and rationales the use of health services to limit them (for example, treating physicians in France).
The comparison of expenditure levels between public systems and competing systems is therefore biased because they are systems which are not comparable in their use.
In the United States, health insurance is mainly dependent on private insurers. Public authorities guarantee care to the elderly (Medicare) or the poor (Medicaid). On the other hand, and contrary to popular belief, even non-insured people have access to free health care from public hospitals, community health centres, teaching hospitals, etc. According to OECD data, public health spending is $2,464 per capita.
Age and income as variables involved for health insured American populace
In 2010, 83.5% of Americans had health insurance and 50 million had no health insurance. However, this rate must be put into perspective: half of the uninsured are under 35 years of age, and the distribution of uninsured persons by age group means that 95% of health problems affect insured populations.
In addition, two-thirds of the uninsured have incomes above $25,000 and households with incomes below the poverty line account for only one-fifth of the uninsured.
Bundorf and Pauly on health insured populace of the US
According to Bundorf and Pauly in the Journal of Health Economics, “up to three-quarters of American uninsured people could afford health insurance without breaching their budget constraints.” It is therefore rather voluntary non-insurance.
A significant part of the contributions, 30%, is not reinvested in health but shares in administrative costs, marketing and profits. Health insurance costs twice as much as in France: 5,500 dollars per person in 2005, this represents 16% of the GDP.
Obama’s health insurance reform
The health insurance reform sought by US President Barack Obama was passed by the Senate in November 2009 and by the House of Representatives on 21 March 2010. It obliges all Americans to take out insurance before 2014 under penalty of amendment.
It prohibits insurance companies from refusing to cover insured persons because of their medical histories. It provides financial assistance to families with incomes below $88,000 per year.
The reform is expected to cost $940 billion (€695 billion) over ten years. Its funding should be provided by high income taxes and lower healthcare spending.
Best health insurance in Texas:
Sometimes getting good health insurance in Texas isn’t easy. Showing concern for your health and that of your family is normal. If you’re a Dallas or Austin resident, it’s normal to wonder how to get health insurance.
Therefore, in this delivery we bring you the best health insurance in Texas.Even when not required, good health insurance can protect your family from the high costs of emergency health care and better balance routine medical expenses by making them more predictable.
Which of all health insurance in Texas provides the best coverage at the best cost? Read carefully the series of tips and recommendations on the best options for affordable health insurance in Texas.
Well-tailored health insurance
We will help you find health insurance according to your possibilities so that you have adequate medical coverage for an eventual illness or injury.
Throughout Texas, there are several insurance companies that offer fairly affordable health insurance. People in formal employment often get health insurance through their employer, although they can also buy health insurance independently through a private company or through a state exchange.
As we investigate the different health insurance options available, we can find different terms that explain your financial responsibility for payments and coverage.
It is important that we become familiar with the workings of health insurance and know where we will be responsible when we use the service.
Let’s look at the most basic terms in health insurance:
Health insurance premium
The insurance premium is the cost of taking out insurance or the payment we will make to the insurance provider each month, thus keeping the coverage active.
A health insurance deductible is the amount you must pay before the insurance coverage takes care of the rest of the medical bill.
Generally speaking, most insurance plans have high deductibles and low premiums, that is, the lower the deductible, the higher the premium payable.
A health insurance copay is a small amount of money you pay when you visit your doctor or specialist. For example US$ 20 per pediatric consultation.
The copay doesn’t count towards your deductible.
This is the percentage of the total cost that both you and your insurance company cover. It is often written as 80/20 or 70/30.
These proportions mean that the insurance covers 80% or 70% respectively, and you will be responsible for paying the other 20% or 30%.
Average cost of health insurance in Texas
Texas residents pay an average of $440 per month in health insurance premiums.
A health insurance doesn’t have the same long list of discounts that we can access on car insurance or housing insurance, but there are a few things you can do to help reduce and keep health insurance costs at bay:
Maintain a healthy body mass index (BMI)
Since you exercise and maintain a healthy diet are the pillars of a healthy and uncomplicated life. Because it is clear that a high body mass index increases the chances of chronic conditions, such as diabetes, high blood pressure and heart disease.
Eat well and exercise often to get a proper BMI or body mass index. This will reduce health insurance premiums.
Stop using tobacco
About 16 percent of people in Texas smoke. Are you one of them? Well, bad news for you.
Smokers pay higher health insurance rates. Don’t even think about starting to smoke, and if you already do, take steps to quit.
Your age will affect health insurance costs
Hopefully, younger people tend to have fewer health problems and pay less in health insurance than older people.
You can’t do anything to change your age, but you can take steps to improve your overall health and that of your family group.
You may not be paying much attention today, but you’ll make sure you pay less in time for health insurance when you have to see a doctor or specialist.
Types of health coverage in Texas
There are several types of health insurance coverage in Texas. Here are the most common:
Health Maintenance Organization (HMO)
An HMO (Health Maintenance Organization) plan is called by Aetna.com as “a plan with friendly price”.You will have a network of specialists, doctors and hospitals who have agreed to reduce certain fees to help streamline medical treatment and simplify costs.
But you won’t get coverage outside that network.
With an HMO health plan you can choose a primary care doctor who is responsible for your overall care. And you will need to get a referral from that primary care physician to be referred to a specialist within HMO coverage if necessary.
There is very little paperwork to deal with when you are a beneficiary of an HMO program and the costs are among the lowest available from health insurance providers.
Preferred Supplier Organization (PPO)
In English it is known as “Preferred provider organization” Aetna.com considers it “the most flexible plan”.
A PPO plan is similar to an HMO as you will also have a predefined network of health care providers.
You will save more money by staying in the network, but you will also have the possibility of receiving medical care from providers outside the PPO network, at a slightly higher cost, as you will pay only a surplus for leaving the network.
PPO astonishing facts:
You will not have a primary doctor on your PPO plan and you will not need a referral to a specialist. In contrast, you’ll need to do more paperwork, especially if you’re leaving the network for care or medical treatment.
You will need to apply to the PPO administration for reimbursement of some of the expenses.
Keep in mind that the amount you will be reimbursed varies according to the plan, so be sure to ask the provider what you can expect from your out-of-pocket expenses with several options, which you usually frequent with your family group.
Service point plan (POS)
Insurance company Aetna calls it “the affordable plan with off-grid coverage”.A POS health plan combines facets of an HMO and a PPO. You will pay the cost in advance at your doctor or hospital and then the bill is reimbursed by the POS provider.
This type of health care plan gives you the greatest freedom to see any doctor or visit any hospital you want and you don’t need a referral to consult a specialist on or off the net.
What does health insurance cover?
With the entry into force of the ACA Act or Patient Protection and Affordable Care Act (OBAMACARE), “10 essential benefits” were included that will be part of any health insurance policy in the United States.
It was able to standardize services and allow for a better comparison, since it was previously difficult to compare insurance plans because of the variety of providers and what they included or not in each of their plans.
Let’s look at what health insurance in Texas covers from a basic or essential point of view.
Best health insurance in Texas – 10 essential benefits.
Outpatient service: Every policy must include outpatient hospital care that can be received outside a hospital.
Emergency service: It is mandatory to include emergency medical and hospital care in any hospital, also emergency surgeries, both institutions that are inside or outside the network.
Hospitalization: Policies should include overnight stays, as well as medical treatments prescribed and administered by doctors or nurses.
Pregnancy, maternity and newborn care: All care provided before, during and after pregnancy-childbirth is included.
You should also consider any complications that may occur in labor or pregnancy.
Mental health treatment and substance use: another essential service to be included in health insurance is coverage for mental health therapies, psychological and psychiatric services for hospitalized patients and treatment for substance use.
Prescription drugs: Policy providers will most likely implement what is known as “staggered therapy”.
That is, they may require you to use generic treatments that are less expensive before going to brand-name drugs. By law insurance companies will not be able to avoid covering prescription drugs
Other essential health insurance benefits in Texas
Rehabilitation services and devices: All types of services and devices for physical therapy, occupational therapy and mobility devices shall be included.
Laboratory Service: Blood, urine, and medical imaging samples within medical centers and hospitals are covered.
Preventive service and wellness exams: Physical exams, vaccines and booster injections. Some health insurance plans provide this service free of charge.
Pediatric Service: Children have extensive coverage of services under the ACA Act, including health, medical specialties, vision, and dentistry.
Adult vision and dentistry is not required in the ACA and it is generally very likely that you will need to purchase additional services from your policy provider.
Additional for women
Breastfeeding support: Health insurance policies should include advice and equipment for breastfeeding mothers.Birth control: There are certain FDA-approved birth control methods that are included within the essential benefits of the ACA Act. Emergency contraception is included but not those seeking the termination of a viable pregnancy.
What’s not covered by health insurance?
Let’s look now at what is generally not covered in Texas health insurance plans:
Male birth controls: Methods such as vasectomy or barriers do not include health insurance policies, they are not considered as an essential benefit.
Travel Vaccines: When you travel, any required vaccine is considered “elective prevention” and is not covered. There is only the obligation to cover with those vaccines that are absolutely necessary and routine.
Vision and dental coverage: We mentioned earlier that only dental care and vision expenses for children are covered.
You may be able to receive dental and vision coverage separately through your insurance provider. This is known as an additional clause and you will generally incur an additional fee for that coverage.
Weight loss surgery: They are not an essential obligation for health insurance companies, but some choose to include it. If it is of your special interest, consult before contracting the policy.
Cosmetic surgeries: Obviously, medical insurance does not cover cosmetic surgeries because they are not considered medically necessary.
Unless the treatment you need provides essential benefits, they will not be covered by health insurance.
Contact your insurer
If you have any questions about a specific treatment or service, contact your insurance company.
As you get a quote from the Texas health insurance providers listed below, be sure to ask if they also offer vision, dental, and prescription drug coverage and what the associated costs are.Finding the best health insurance in Texas will depend on how well you know your medical needs.
For example Are you looking for lower-cost premiums or a lower deductible? Do you want dental and vision coverage or just coverage for hospital care and wellness visits? Are you particularly interested in obesity surgeries and treatments?
We’ve chosen the top five health insurance providers in Texas to help make your search even easier.
Scott & White health plan
The Scott and White company received praise from the National Quality Assurance Committee (NCQA), and even obtained the designation of «best in the state of Texas».
Scott & White Health plans are available in HMO and POS form for greater flexibility and affordability.
There are several types of individual and family health plans available and they have an easy-to-use App that keeps your information and identification available for faster access when you visit doctors and hospitals across Texas.
Aetna offers the 3 types of health insurance plans in Texas: HMO, PPO, and POS, so you’ll have a high degree of freedom to decide between the doctors and specialists you want to consult.
This company was highly rated by the NCQA for the quality of the care received and the coordination of the care of its beneficiaries.
This insurer also offers comprehensive benefits and rewards to start and maintain a healthy lifestyle, including discounts for health products and exercises.
It’s a great option if you want to manage chronic health conditions and want to stay up to date with your health care goals.
Community First health plans
Community First Health Plans is a non-profit health insurance company owned and operated locally in the state of Texas.
Affordable Health Insurance remains an important part of your existence no matter which state you are living in at the moment but if you are living in Texas it gets a greater increase in its importance as Texas is the largest of all fifty-two states we have in our beautiful country that is a leader to the world and is known to the humanity as the United States of America.
Big state means big issues and since Texas is the largest in the geographical area so also expect a profusion of issues to be confronted with which can also turn themselves tactfully into the threats to your very existence therefore it is safe to conclude that it is pivotal to have a genuine provision of health insurance with one’s self in a state like Texas.
But the real question remains how to get an affordable one as that remains the biggest concern as compared to merely obtaining some health insurance.
Now is the time to understand in great detail why this insurance is and how you can get it right in the largest of all what we have got as a state in America.