Health Insurance Plans Texas

Health Insurance Plans in Texas

Health insurance plans in Texas are offered through many modes including private insurers, state and federal government-run programs, etc. Individuals, families, small groups, small and medium businesses, students and senior citizens: all have many different types of health plans offered by state government’s agencies and private insurance companies in Texas.

On a very broad measure, health insurance plans in Texas are categorized in two categories: indemnity health plans and managed care health plans. Indemnity plans offer freedom of seeking any doctor or physician. However, managed care health insurance plans have their own network of doctors, physicians and hospitals. If a consumer wants to visit a doctor outside the network, managed care health plans won’t reimburse the whole amount of the claim. Some of them even do not allow it and there would be no reimbursement for the same. As a consumer you should buy a managed health care plan only if you feel there are good and enough doctors and physicians in your area.

Types of Indemnity health insurance plans:

Reimbursement of actual charges: In this plan, the insurer reimburses the insured for the actual cost of medical care.

Reimbursement of a percentage of actual charges: in this plan, insurer pays a percentage of the medical bills on covered services and procedures.

Indemnity: in this plan, the insurer gives the insured a specified amount per day for a predetermined number of days regardless of the actual cost of care. The reimbursement will be reduced if the actual expense is on the lower side

Types of Managed care health insurance plans

Health Maintenance Organizations (HMOs): Health maintenance organizations are prepaid health plans and as a member of this plan, a monthly premium is paid by the member.

Point-of-Service Plans (POS): POS insurance plans are similar to HMOs but members are free to opt out for doctors outside the network but still getting some coverage.

Preferred Provider Organizations (PPOs): Preferred provider organization is a combination of traditional fee-for-service and an HMO.

Apart from these traditional health plans, Texas also has Medicare, Medicaid, CHIP, and high-risk pool offering various options to the residents.