When it comes to health insurance, Texas is ranked worse than average. The Lone Star State landed number 38 in a study by US News that considered health care access, quality, and good public health.
Health insurance options in Texas
According to the Texas Office of the Commissioner, as a Texas resident there are several ways you can get health insurance:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Texans get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 47% | ||
| Individual or family | 6% | ||
| Medicaid | 17% | ||
| Medicare | 10% | ||
| Military | 2% | ||
| Uninsured | 18% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
At 18 percent, Texas has the highest rate of uninsured residents in the US. This means that Texas is way behind other states when it comes to health insurance. This isn't good for policyholders because the more uninsured people in the state, the higher rates are.
Best health insurance companies in Texas
Luckily, Texas has plenty of options for health coverage. These health insurance companies offer coverage for individuals and families:
Blue Cross Blue Shield of Texas
Blue Cross Blue Shield of Texas offers several care options, including a 24/7 nurse line, a provider finder tool, and virtual visits that allow you to have a live consult with doctors. BCBS offers bronze plans, silver plans, and gold plans, which cover 60, 70, and 80 percent of your medical costs, respectively. You may also qualify for financial assistance programs that help lower your costs. The specific health care professionals and hospitals available to you vary based on your plan type.
Blue Cross Blue Shield of Texas has worked with state non-profits for the past 90 years to offer health-focused programs. The company is an independent licensee of the Blue Cross Blue Shield Association and is statewide and customer-owned.
Celtic/Ambetter
Ambetter sells three levels of plan options: Essential Care (bronze), Balanced Care (silver), and Secure Care (gold). The higher level of plan, the more you’ll pay monthly, but the less you’ll pay for out-of-pocket expenses. Ambetter contracts with health care providers like primary care doctors, specialty physicians, hospitals, pharmacies, and more. The company also offers benefits like a 24/7 nurse advice line, a rewards program, telehealth services, and more.
The Ambetter Superior HealthPlan is a localized health care provider in Texas. The company aims to offer high quality service to members.
CHRISTUS
Bronze, silver, gold, and platinum plans are all available as coverage options with CHRISTUS. These plans include coverage for a primary care physician, hospital benefits, prescriptions, and more. You’re eligible for CHRISTUS if you live in Texas and
- You’re retiring early
- Don’t have full coverage through an employer
- Were recently dropped from your parents’ insurance plan
- Don’t have health insurance
CHRISTUS’ mission is to “extend the healing ministry of Jesus Christ.” The provider is a not-for-profit Catholic system with a large network that extends over Colombia, Chile, Mexico, and certain southern US states. The network encompasses 600 centers and 15,000 physicians.
Community Health Choice
Community Health Choice offers a CHIP plan, STAR plan, and marketplace plans. This company offers benefits like a 24/7 nurse hotline and membership to neighborhood centers, childbirth classes, transportation assistance, and more. If you enroll in a marketplace plan, you’ll have access to Teladoc, which allows you to speak to a doctor, as well as a Wellness Incentive Program.
The Community Health Choice mission is “to improve the health and well-being of under-served residents of Southeast Texas by opening doors to coordinated, high-quality, affordable health care and health-related social services.” The non-profit health plan started 20 years ago and includes a network of 10,000 doctors and 77 hospitals.
Molina
With Molina, an individual plan will cost you anywhere from $525 to $6,400 in deductibles. A family plan will cost $1,050 to $12,800 in deductibles. Molina emphasizes quality care, easy access, and friendly customer service. Benefits include
- Government-sponsored care programs
- 24-hour nurse advice line
- Online health plan portal
- Large network of providers
The company also offers health education courses including weight management, help to stop smoking, and maternity education and services.
In 2005, Molina started serving Texas residents. The company offers care to over five million individuals and families and spans across 15 states. Their mission is to “provide quality health care to people receiving government assistance.”
Oscar
Oscar provides a doctor available for phone calls 24/7, an easy-to-use app, and a personalized Concierge team. The Concierge team consists of care guides and a nurse that can check provider availability, solve issues, match you with doctors, and more. Oscar offers bronze, silver, gold, and platinum plans, which cover 60, 70, 80, and 90 percent of medical bills. You can choose any of these “metal tiers” for whichever Oscar plan you choose. Plans include the Backup Plan, the Simple Plan, and the Classic Plan.
The company was founded in 2012, and now the network covers over 250,000 individuals and businesses.
Sendero
Sendero’s insurance plans are called IdealCare. Their health care plans cover doctor visits, hospitalization, maternity care, emergency room care, and prescriptions. You qualify for IdealCare if:
- You have no health insurance
- Are between 18 and 64
- Live in Travis, Hays, Bastrop, Burnet, Lee Caldwell, Fayette, or Williamson counties.
Plan types include Essential (bronze), Complete (silver), Total (gold), and Premier (platinum). Sendero also offers wellness programs like smoking cessation, asthma prevention and management, diabetes prevention and management, and more.
Sendero is a non-profit organization that was founded in 2011. Their mission is dedicated to “mproving the health of the community by providing affordable, quality healthcare coverage.”
FirstCare
FirstCare has several plan types including bronze, silver, and gold. Individual plans will cost you up to $6,550 in yearly deductibles, and family plans will cost up to $13,100 in yearly deductibles. All marketplace plans offer full coverage for preventive care, routine labs, x-ray services, and pharmacy benefits. FirstCare also offers health and wellness benefits such as maternity programs.
Founded in Amarillo, Texas in 1985, FirstCare now has a network of more than 160,000 community members. The company is owned by two hospitals, Covenant Health and Hendrick Health System. The TX company offers plans in 143 counties.
Friday Health Plan
Friday Heatlh Plan is a newcomer to the Texas health care exchange in 2021. The insurer offers a variety of plan types:
- Individual
- Group
- ICHRA
- Health network
- CHP+
- Medicare
Friday currently covers over 15,000 members. The Denver-based company says they design their products wth simplicity and affordability in mind.
Scott & White
Scott & White has both HMO and EPO plans. Both HMOs and EPOs require that you use in-network providers, though specifics for referrals and primary care physicians vary. Plan specifics are relatively similar, but the type of plan you can get depends on the county you live in. Hays, Bastrop, and Walker counties only have the HMO plan available.
The Scott and White Health Plan has been serving TX residents since 1982. Their mission is “to be the most trusted name in giving and receiving safe, quality, compassionate healthcare.” SWHP was first known as Centroplex Health Plan, and since then has had over 230,000 members and serves 77 counties.
Baylor Scott & White
Baylor Scott & White offers plans through the Scott & White Health Plan. This health plan provide HMO and EPO plans, which vary depending on the county you live in. The company also offers wellness classes to members, including yoga, walk-in flu clinics, and breastfeeding classes. They have an expansive network of specialties and services, ranging from sports medicine to neuroscience.
Baylor Scott & White turned into the largest not-for-profit health care system in TX after the 2013 combination of Baylor Health Care System and Scott & White Healthcare. Their network now includes 48 hospitals, more than 800 patient care sites, over 47,000 employees, and more than 7,800 physicians. Their mission is: “Founded as a Christian ministry of healing, Baylor Scott & White Health promotes the well-being of all individuals, families and communities.”
Texas health insurance costs and rate factors
Texas residents spend an average of $6,998 per year on health care expenditures, less than the national average. What factors into insurance rates for Texans? Health insurance prices are greatly dependent on the individual. Here are some of the key influencers in how much you'll pay:
Plan type
It makes sense that the more coverage you want, the more money you need to pay. The health insurance marketplace tracks this coverage in metal tiers: bronze, silver, and gold.
So, how much can you expect to pay for health insurance in Texas? The table below showcases the average monthly premium for each plan type for a 40-year-old Texan in 2020.
| Bronze | Silver | Gold | |
|---|---|---|---|
| $295 | $418 | $471 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
In Texas, a gold plan premium costs about 60 percent more than a bronze plan. This price bump is worth it though, gold plans offers 80 percent coverage, while bronze plans only cover 60 percent. Spending more on monthly premiums means that if something happens, your insurance covers more of the medical costs.
The lowest type of medical coverage is a catastrophic plan. This coverage has low premiums, but a $8,150 yearly deductible. With a catastrophic plan, most routine medical costs would come out of your pocket. Investing in bronze or silver plan will likely save you money when you need to use your health insurance.
Body mass index
Statistically, a high body mass increases your risk for serious health conditions. Because of this, health insurance companies look at your BMI to determine your risk-level. The higher the BMI, the higher your health insurance rates.
2018 data shows that Texas had a 35 percent obesity rate, making it the 10th most obese state in the country. Out of the many Texans who used QuoteWizard to shop for health insurance, 37 percent have a BMI in the obese range.
Tobacco use
Tobacco use causes several serious health issues. Insurers know this, and your rates will be higher if you're a smoker. About 15.7 percent of Texans are smokers, the 17th lowest rate in the country.
Age
Health insurance premiums can be up to three times higher for older people than younger people. TX residents who used QuoteWizard to compare health insurance plans are, on average, 40 years old.
Location
According to the Texas Department of Insurance, your zip code influences how much you'll be paying for health insurance. Your state's different laws, regulations, and healthcare providers also play a role.
Your health insurance rates don't only depend on your individual habits, but also those of your neighbors. Rates are dependent on how many claims the people in your state file on average, so if they file claims at a higher rate, your premiums could spike. That means that overall health of people in your state affects insurance costs. Texas is less healthy than the national average, ranking 34th in comparison to the rest of the states.
Texas medical insurance laws
The Affordable Care Act (ACA) provides limits on what insurance companies can use when pricing your policy.
- Pre-existing conditions: Before the ACA, people with pre-existing health conditions like asthma, diabetes, or cancer struggled to find affordable coverage. Now, Insurance companies can't charge higher rates to people with pre-existing conditions.
- Gender: Though women pay about a third more for health care than men, the Affordable Care Act states that men and women must be charged the same premiums for the same plan.
- Insurance and medical history: Insurance companies used to look at medical histories and past insurance coverage before the ACA. If you were someone with a medical problem or insurance issues, you would be forced to pay more in premiums. Sometimes, insurance providers even denied coverage outright.
There is a federal law that sets the bar for the most you can pay for covered services. For 2018, the out-of-pocket maximum for a Marketplace plan is $8,150 for an individual plan and $16,300 for a family plan.
According to the Texas Insurance Code (TIC), insurance companies must provide residents with at least some coverage for these services:
- Cancer screenings
- Maternity minimum stay (if covered)
- Brain injuries
- Cancer medications
- Prosthetic and orthotic devices and related services
- Reconstructive surgery following a mastectomy
Find the full list of benefits and how they vary based on individual and large group employer plans here.
Medicare and Medicaid in Texas
Federal- and state-funded health care programs Medicare and Medicaid offer coverage to many people across the nation. The programs provide coverage to two different groups of people: seniors and low-income families. Medicare offers health coverage to seniors, and Medicaid helps low-income families and children.
Medicare
Medicare is a program that offers affordable health care for seniors over 65-years-old that are also qualified to receive social security. There are multiple types of coverage within Medicare, labeled as types A, B, C, and D, in addition to supplemental insurance.
Texas residents who are eligible for Medicare have the option of joining the Texas Health Information, Counseling and Advocacy Program, which offers information and education about Medicare. In the state of Texas, you may also qualify for the Medicare Savings Program if you meet these requirements:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Over four million low income Texans have access to healthcare through Medicaid and CHIP. To qualify for these government-funded health care programs in Texas, you must meet these financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $25,265 |
| 2 | $34,136 |
| 3 | $43,006 |
| 4 | $51,876 |
| 5 | $60,747 |
| 6 | $69,617 |
| 7 | $78,488 |
| 8 | $87,358 |
Texas Department of Insurance
- Website:
- Homepage
- Insurance Commissioner:
- Kent Sullivan
- Insurance Hotline:
- (800) 252 - 3439
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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