Texas Health Insurance FAQ's

What is a deductible?
A deductible is the amount of money paid toward the cost of medical expenses you are responsible for before your insurance starts to cover them. For example, if your Texas Health Insurance policy had a deductible of $1,000 per person you would be responsible for paying the first $1,000 in medical expenses before the co-insurance would kick in. A higher deductible will usually lower monthly premiums.

What is co-insurance?
Co-insurance is your portion that you are responsible for paying after your deductible has been met. Unlike a co-payment, which is a fixed-dollar amount, coinsurance is expressed as a percentage. For example, many Texas health insurance plans have 20% coinsurance for hospital costs meaning you pay 20% of the total cost of a trip to the hospital. You may offer hear the term 80/20 plan in regards to this.

What is a co-payment?
A co-payment is generally used in the types of plans most people are used to and is a fixed dollar amount for certain services. A co-payment is generally used for regular office visits to the doctor. A regular office visit usually consists of visits for common illness that doctors require treatment other than for medication (amongst other relatively minor visits). Co-payments are also available for annual preventative and OBGYN check-ups. Most Individual and Family Texas health insurance plans offer doctor co-pays from $25 to $50 per visit.

What is a premium?
A premium is the monthly payment that keeps your insurance policy in effect. Initially, Texas Health Insurance premiums are regulated by the state based on your primary residence (zip codes). That means you could visit many websites that offer health insurance illustrations and the premiums would start out all the same price. However, once the medical underwriting begins, your health premiums may vary due to the following:

1. Pre-existing medical conditions (High Blood Pressure or High Cholesterol)
2. Medications, if any
3. Height and Weight
4. Smoker or Non Smoker

We have the underwriting manuals for all of our Texas Health Insurance Companies which enables us to pinpoint which health insurance plan would be the best plan for you and your family.

What's an out-of-pocket expense?
For any Texas Health Insurance plan your out-of-pocket expense (or OOP) is your cost tied into your co-insurance you have to pay yourself when receiving medical care. Your deductible, co-insurance, and out-of-expense are your total out of pocket expenses. Once your out-of-pocket expenses are met, then your insurance company pays 100% for any additional medical costs.

For example, if you applied for a Texas Individual Health insurance policy and your plan had the following features:

Deductible: $1,000
Co-Insurance: 80%/20%
OOP: $3,000

Your doctor informs that you need major surgery. Total Cost after PPO negotiated rates $25,000. You would pay the following out-of pocket expenses:

$1,000 Deductible
$3,000 OOP (20% Co-Insurance Maximum)

Your Total Out-of-Pocket Expenses: $4,000
Your Insurance Company then pays the remaining: $21,000

Most policies have an annual maximum out-of-pocket expense. Once you've paid out enough money to meet that maximum, your insurance company will pay the rest of your medical costs.

What is managed care?
Managed care is a form of health insurance that stresses preventive medicine and affordability. In a managed care plan, you typically choose a Primary Care Physician who is responsible for approving specialist and hospital care. Managed care was originally introduced as a way to control healthcare costs. It's now the most common form of health insurance in the United States. HMOs and PPOs are examples of managed care.

Why should I buy health insurance in Texas?
First, did you know that 60% of all Personal Bankruptcies in America are due to medical bills?. Having health insurance is not just about paying your medical bills. It's about knowing that you'll always have access to quality care. Health insurance makes seeing the doctor easy and affordable and that means you're more likely to stay healthy.