How to shop for low cost health insurance in Texas

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If you’re shopping for health insurance, make sure you know what you’re buying. there are many options today. some may have fewer benefits and more limits than traditional health insurance. learn more about alternative health plans.

if you’re shopping for an affordable care act (aca) plan, visit healthcare.gov or ask your agent if the plan is an aca plan. You can buy insurance in the federal marketplace during open enrollment and special enrollment periods.

You can use this checklist to decide about health coverage.

print this checklist (pdf)

regulation

• is this insurance? Or is it a discount card, a shared health ministry, or another non-insurance product?
• How long does this plan last? Do I have the right to renew it if I want? or can the plan deny me at renewal?
• Who regulates this plan or product? (is it the state, the federal government, anyone?) Who do I complain to if I have a problem?

covers

• Does the plan cover pre-existing health conditions, such as diabetes and high blood pressure?
• Is emergency care covered?
• Are hospital stays covered? Is there a limit to the number of days?
• What doesn’t the plan cover, like pregnancy or mental health?
• Do I get drug coverage with this plan? If so, are brand name drugs covered or only generics? Does it cover the medications I take?
• Does the plan limit the number of times I can see a doctor?
• Is lab work covered?
• Is there a waiting period before I can start using this plan?

costs

• can I get a subsidy from the marketplace to help pay for this plan?
• Is there a limit on how much I have to pay out-of-pocket for covered health care?
• how much is the deductible? (That’s the amount you’ll have to pay before the health plan pays.)
• what are the copays? (These are set amounts you’ll pay for certain services. For example, an emergency room visit may have a $200 copay.)
• Will I pay coinsurance (a percentage of the costs) for certain services?
• Does the plan pay my medical providers? Or do you pay me and I pay the medical bills?

doctors

• Do I have to use doctors, hospitals and urgent care centers in your network or can I use any I want?
• Do I have to ask the plan before I can see a specialist?
• can you check if my current doctor is in network with this plan?

avoid scams

here are some warning signs that you might want to switch to another company.

• The agent or seller cannot answer basic questions about the plan, like those on our shopping checklist.
• you feel pressured to decide right away. there are no limited time offers on health insurance. no one can promise you special treatment.
• A price that is much lower than other companies you’ve checked with likely means the plan has fewer benefits and more limits.
• You receive a call or email from a company or person you didn’t contact first.

need more help?

Call our help line at 800-252-3439 to see if a business is licensed, check their complaint history, or ask questions. You can also use our list of companies that sell plans in Texas.

resources

• texashealthplancompare.com: See side-by-side comparisons of texas health plans.
• texas health options: compare health plans, benefits and networks. learn more about how to use your health plan.
• How to Shop for a Health Insurance Plan (Video): When shopping for health insurance, learn your needs, ask questions, and compare plans.
• Health Plan Report Cards: The National Committee for Quality Assurance Measures and Accredits Health Plans
• hmo report cards: from the public insurance attorney’s office