Shopping Around: How to Qualify Health Insurance Providers in Texas


In 2021, about 18% of Texans didn’t have health insurance, a greater percentage than any other state. If you want to avoid being part of the statistic in future years, you need to compare health insurance providers in Texas.

That way, you can look into available plans and estimate your overall health care costs. Read on to learn how you can narrow your search to find the best health plan.

Start With Your Employer

Before you start shopping for health insurance, you should consider if you or your spouse can get an employer plan. In general, these plans offer the best coverage for the most affordable price.

However, a lot of Texans are self-employed, so you might not have access to this, especially if you’re not married. Even if you do have access to an employer plan, it might not be the best.

You should still compare insurance costs and benefits. But an employer plan is a good place to start if it’s an option for you.

Understand the Types of Plans

Whether you go through an employer or shop for health insurance yourself, you need to compare different plans. Most plans are going to be one of four types.

Each type of plan offers unique pros and cons, and one type isn’t the best for everyone. Consider how the four main plan types differ to help select the best option for you and your family.

Health Maintenance Organization

A health maintenance organization (HMO) is a limited type of health insurance. You have to choose from a very small network of providers for the insurance company to cover your care.

Also, you’ll work with a primary care provider (PCP) who will manage all of your care. If you ever need to see a specialist, your doctor will refer you to one.

However, HMOs tend to be some of the most affordable plans on the market. So if you’re looking to save money and aren’t very picky about where you can get care, this plan type might work for you.

Preferred Provider Organization

A preferred provider organization (PPO) offers more choices for doctors than an HMO. That means you can see almost any doctor you want as long as the doctor is in your plan’s network.

If you need or want to see a specialist, you can do so without having to visit your PCP first. You can even see providers who are out of network, and you can file a claim to get your plan to reimburse the cost.

Unfortunately, accessing these benefits can increase the cost of these plans. That means they may not be the best if you just need a basic health plan.

Exclusive Provider Organization

An exclusive provider organization (EPO) is very similar to a PPO. The most significant difference is that your health insurance company won’t reimburse you if you get care out of your network.

Now, they will cover out-of-network services if it’s an emergency. However, you can’t choose a PCP or specialist that doesn’t contract with your health plan if you want reimbursement for the cost.

EPOs have very little paperwork, and they may even come with a slightly lower premium than PPOs. But they can still be a bit more expensive than an HMO.

Point of Service

If you can’t decide between an HMO and a PPO, a point of service (POS) plan could work. You have to visit a PCP and get a referral before you can see a specialist, like in an HMO.

However, you have more flexibility to receive care outside of your network, like with a PPO. You’ll need to pay more for that care than if you went to a doctor in your network.

Now, if your PCP refers you to a doctor who’s out of your network, your plan may still cover the cost.

Decide If You Want to Deal With Referrals

As you compare health insurance providers in Texas, consider if you want to get referrals for specialist care. If you don’t have a ton of health concerns, you may not mind seeing your primary care doctor.

However, if you have a chronic illness, you might have a specialist that you like to see. You may luck out and have your PCP refer you to that specialist, but they may refer you elsewhere.

So if you want more control over the doctors you see, a PPO or EPO will be a better plan for you. If you don’t care as much about controlling the doctors you see, you can go with an HMO or POS plan.

Review Your Current Medical Needs

One of the most vital things to consider when choosing health insurance is your existing medical conditions. If you take prescription medications, you should look for insurance plans that will cover the medication.

At the very least, consider if an insurance provider will cover the generic version. Then, you won’t have to spend hundreds or thousands of dollars to manage your current conditions.

You should also look at when you need coverage and if you need a temporary plan. Temporary plans come in handy when you lose coverage outside of the open enrollment period.

On the other hand, maybe it is open in enrollment, and you know you need coverage for the upcoming year. Then, you can shop for an insurance policy accordingly.

Contact Your Doctors

If you already see doctors that you like, call their office or visit them in person. Ask for a list of insurance plans they accept so that you can compare that list to the policies you qualify for as you shop for insurance.

Some doctors or hospitals even list their accepted plans on their website. So you can start there and not have to contact the doctor at all.

If you find that one of your doctors doesn’t accept a plan that you may choose, you can still visit them. As mentioned, most plan types let you obtain care out-of-network.

In that case, you still want to contact the doctor to ask about their cash rates. The rate will usually be lower than what they charge insurance companies, so you can visit your preferred doctors without choosing a plan they accept.

Consider Your Family Situation

Whether you just got married or had kids, you should consider if you’ll need to add anyone else to your health insurance. Adding a spouse, child, or both can increase the cost.

Of course, it also allows them to receive care under your plan, so the added cost can be well worth it. You can usually add your spouse and any children up to the age of 26 to your plan.

If you need to add any dependents, be sure to consider their doctors and medications. Make sure whatever plan you choose will cover everyone’s medical needs.

You should also consider if your family situation may change soon, such as if you’re pregnant. Then, you can choose a plan that will make it easy to add the new family member.

Learn About Emergency Care Coverage

The best health insurance providers in Texas should offer coverage in case of an emergency. You may not want to think about this, especially if you don’t have any health problems.

However, you never know when you may get sick and need to visit the emergency room. Not having insurance can cost a lot if you get sick or injured and need care.

As you compare health plans, see what sorts of emergency services they cover. They should include in-network and out-of-network providers for emergencies.

Knowing that is particularly important if you tend to travel around Texas or the United States. That way, you can still get care when you need it while you’re out of town.

Look Into a High-Deductible Health Plan

While it’s not for everyone, many people like having a high-deductible health plan. For one, these plans qualify for a health savings account (HSA), so you can save tax-free money for qualifying health expenses.

The higher deductible also means you’ll usually get a lower premium than a similar traditional health plan. That can make this type of plan a good choice if you don’t have many medical issues.

If you visit the doctor often or take a lot of medications, may not be more cost-effective for you. However, it can be nice to save money without owing taxes on it, and you can use those funds for medications, doctor appointments, and more.

Think About Your Budget

Before you choose a health insurance policy, consider how much you can afford. In most cases, an individual plan will cost less than a family plan, so keep that in mind before adding people to your policy.

As you look at your budget, you need to account for your monthly premium. However, you also need to consider the deductible and the likelihood that you’ll hit that deductible.

Think about how much you’ll pay in copays for appointments and medications. If you already have an HSA, you should then consider how much you’ll contribute to that account each month.

You can then subtract your monthly expenses from that savings number, aside from your premium. If you’ll spend less per month on care than what you save, you can keep your overall costs relatively low.

Estimate Your Out-of-Pocket Costs

Keep your budget in mind as you review the best health insurance providers in Texas. Before you select a plan, get out your calculator and make a spreadsheet with some numbers.

Include the top plans you’re considering and list the premium, deductible, and copays of each. Calculate how many times you expect to pay a copay and how much of your deductible you expect to meet.

Then, you can add up all of those numbers for the year to get an estimate of your total cost. Now, some insurance websites will calculate this for you, but they don’t know your exact situation, so the number may not be accurate.

Adding everything up yourself can give you a better idea of your annual cost of care. Compare the numbers to your budget to help find a plan that you can afford and that meets your needs.

Don’t Just Shop the Marketplace

The Affordable Care Act (ACA) marketplace is an excellent place to start looking for plans. However, you may be able to find Texas health plans off the marketplace.

If you compare plans on the marketplace and can’t find one that suits your budget, don’t stop looking. Consider other plans that may offer similar benefits but for a lower cost.

Look at the websites of brokers or health insurance providers in Texas. Then, you can review the plans straight from the source, and you may discover more options than the ACA has.

If you don’t want to do all of the research yourself, you can work with a broker. The broker will be able to find plans from ACA and elsewhere, and they can help you calculate your potential costs.

Read Plan Reviews

As you narrow your search for the best health insurance, look for reviews of the plan or at least of the company. Pay attention to good and bad reviews, and focus on any comments regarding billing and customer service.

You want to make sure that your plan won’t try to overcharge you for services. And if you ever have questions or concerns, you need to be able to talk to someone who can get you the help you need.

If a health plan offers poor customer service, you can still use it. However, you should enroll in it knowing that there’s a risk you may not be able to contact anyone for assistance with your account.

Now, you can’t always trust reviews, so you may have to go with the plan that feels right. But reading what others have to say about a company can give you more information to help you choose.

Compare Health Insurance Providers in Texas

If you’re looking at health insurance providers in Texas, you have a lot to consider. You need to think about your medical needs and if you need to cover anyone else under your plan.

Of course, your budget might also come into play. Be sure to research multiple health plans and compare the benefits so that you can select the best plan for you.

Do you need help shopping for health insurance? Learn about the best health insurance plans in Texas.

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