Health Insurance Made Easy

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Texas Health Insurance

Are you shopping for a Texas health insurance plan? Are you looking to better understand the health insurance market? Here you will find key resources to help you make an informed decision and an instant quoting tool showing all Texas health insurance options. Start by entering your zip code above to find plans offered in your area.

Facts and Figures

  • Place in State
    Health Report Card
  • Insured 4,944,802
  • Uninsured 4,944,802
  • Insurance
  • Number of
    Primary Care Physicians
  • Number of
  • Avg. Cost of
    Health Insurance Age 27*
  • Avg. Cost of
    Health Insurance Age 40*
  • Avg. Cost of
    Health Insurance Age 60*

Breakdown of Insureds

  • Employer-sponsored health insurance 48%
  • Private plans 6%
  • Medicaid 17%
  • Medicare 10%
  • Others 2%
  • Uninsured 17%

State Health Report Card

Nearly 3.4 million adults in California smoke, about 850,000 less compared to the last decade. There are more than 6.9 million obese adults in California, two million more compared to ten years ago. In ten years, diabetes cases increased from 6.8% to 8.6% among California adults. Today, there are 2.4 million adult Californians living with diabetes. In five years, children living in poverty increased from 18.5% to 23%.

What to Know When Shopping for Health Insurance

Below are some of the most commons concerns when shopping for a Texas health insurance plan.

Are Your Doctors In-NetworkBefore purchasing a health insurance plan you should always make sure that your doctor(s) are part of the network. Going to an out-of-network doctor may cost substantially more than if that doctor is in-network. Don’t just ask the doctor’s office if they accept a certain insurance plan before you enroll. You should always confirm with the insurance company or an agent that your doctors are in-network. Why the concern? Well, keep in mind that if an out-of-network provider suggests services, then all of those services provided by that recommended doctor will be considered out of network, even if the facilities and providers are in-network

Lower Monthly Premium May Result in Higher CostsHealth insurance follows a simple formula: the lower your monthly premium is, the more likely you are to pay higher costs when you use the insurance. If you’re someone who happens to be in good health and does not foresee any health-related issues and doesn’t use medicine on a very regular basis, then perhaps you’re better off opting for a lower costing health insurance plan. However, if you find that your medical expenses and prescription usages are high, then you may save money by purchasing a plan that costs more per month. Be sure to consider your current health condition when shopping for a health insurance plan. 

Health Insurance is a ContractWhen purchasing a plan, both parties agree to live up to the contract (usually for a period of one year). If you find that you are not happy with your plan, you can’t go back to your insurance company mid-year and ask them to change coverage. You’ll have to wait for your contract to expire. Additionally, if you buy an individual health plan on your state exchange or through and you allow that plan to lapse or you stop coverage, then you don’t qualify to buy a health plan on that exchange for the rest of that calendar year. As such, be sure to choose the right plan that suits your needs before signing the contract. 

Types of Insurance Coverage – EPO, PPO, POS, HMO, HDHP and HSA. The first 4 are acronyms that describe different types of health insurance coverage, which provide you with or without the flexibility to see specialists and receive out-of-network and out-of-state care. Also, different plans have different requirements related to the need for referrals. If you’re often seeing specialists out-of-network then you want a plan that offers that flexibility. If you find that you travel often for work or live in multiple states per year, then perhaps a plan that offers that flexibility is needed. The last two types, HDHP and HSA’s allow you to set up a tax-free savings account specifically for qualified medical costs For a better understanding of these types of coverage please refer to the following article.

Metal LevelsIn order to make shopping and comparing health plans easier, a metal system to represent different insurance coverage levels was created. These insurance levels are grouped into 4 metals based on actual metal value. Bronze, silver, gold, and platinum all represent the metal worth and the level of coverage offered under each metal plan. In theory, a bronze plan will cover 60% of your medical costs and provide you with a maximum out of pocket dollar amount that does not equal the remaining 40% but instead is a threshold set for most bronze plans. Silver is set at 70%, Gold 80%, and the most valuable metal platinum is set at 90%. Based on your medical needs you should be able to relatively compare an appropriate metal level. For example, if you find that you have minimal health insurance needs then perhaps a bronze plan would best suit you. However, if your health status requires a good deal of care, then perhaps a gold or platinum plan, which costs more, will actually cost you less in the long run.

Are Essential Health Benefits Covered? One way of ensuring the plan you purchase or intend to purchase covers the 10 essential health benefits, is to buy an on-exchange plan. All exchange plans must cover 10 essential health benefits. This provides you with a guaranteed minimum level of coverage, which is the standard set by the Affordable Care Act. Why would we need a minimum standard level? Well, the cost of medical care is prohibitive without insurance in place and can often lead to financial ruin. Ensuring that a plan includes the minimum essential health benefits provides a safeguard.

Premium, Deductible and Out-Of-Pocket Costs. Each term relates to the cost of using and maintaining your plan.

Premium is the cost of the insurance that you usually pay on a monthly basis to the insurance company. Premiums are often locked in for a period of one year, meaning the insurance carrier cannot arbitrarily charge you a higher premium within that year

Deductible is a yearly dollar threshold that you must meet prior to the insurance company paying for medical services. This almost always excludes preventative care.

Out-of-pocket costs are the maximum annual dollar amount that you can spend on health care services and medicine.

Health Insurance Subsidies A Subsidy is a dollar amount provided by the federal government paid directly to your insurance company based on your current yearly income. This money does not have to be paid back, however, if your income does increase, there is a strong possibility that your subsidy may change, which would then increase your monthly premium (retroactively). Conversely, if your income decreases within the year, that may reduce your monthly premium at which point you have the right to contact your insurance company and inform them of your income change.

Essential Health Benefits

What Are Essential Health Benefits? Essential Health Benefits are a set of 10 health care benefits established by the federal government under the Affordable Care Act of 2014. The purpose is to ensure that all persons are covered by a set of minimum standards. Specific insurance services may vary by state and all plans must provide dental coverage for children. 

1.Ambulatory Patient Services – Medical care provided without admission to a hospital, including doctor’s office visits, clinics, and outpatient surgery centers.

2.Emergency Services – Organizations that are responsible to deal with emergencies when they occur. This includes medical care that if not treated could lead to serious conditions or disabilities.
3.Hospitalization – Medical care that patients receive when they are hospitalized.  This includes the care of nurses, doctors, and other staff. This also includes medication received, room and board, tests and laboratory work.

4.Maternity – Medical care that a woman receives during pregnancy and post pregnancy. This includes labor, delivery, post delivery and the care for newborn babies.  

5.Mental Health Services and Addiction Treatment – Patient care provided to evaluate, diagnose, and treat any mental health conditions or substance abuse disorders.

6.Rehabilitative Services and Devices – Services provided after an injury, accident, disability, or a chronic condition. The purpose is to attempt to help regain the patient’s mental and/or physical skills that were lost (to make the person whole again).

7.Pediatric Services – Medical care that is provided to children and infants, including regular check-ups, recommended vaccines, dental and vision care.

8.Prescription Drugs – Medicine that is prescribed by a doctor, and nurse practitioner, to treat any illness or existing condition.

9.Preventative and Wellness Services and Chronic Disease Treatment – Physicals, Immunizations, and cancer screenings to prevent or detect certain medical conditions, and to provide care for chronic conditions.

10.Laboratory Services – Medical tests that are usually ordered by your doctor which include coverage for X-Rays and diagnostic imaging, blood and fluid tests, biopsies, pathology, and pregnancy tests.

Which Types of Insurance Plans are Not Required to Cover the Essential Health Benefits? The following insurance plan types are not required to include essential health benefits and most often don’t.

     Short Term Medical Insurance


     Critical Illness/Cancer

     Hospital Confinement

     Association Health Plans

     Faith-Based Healthcare

     Large Group Insurance plans (50 employees or more)

     Travel Insurance

     Dual Citizenship insurance (As long as you have proof of Identification)

State Government Insurance Programs Offered

Aging & Disability Resource Center (ADRC-TX)

Health & Human Services Commission (HHSC)
Mail Code W358
PO Box 14930
Austin, TX 78714

TEL: 855-937-2372

Staff members are trained and knowledgeable about programs/agencies that specialize in older adults and the disabled. Examples of potential issues include: health issues such as nutrition and management of chronic medical conditions; adaptive equipment; assistive technology; long term care options; low-income housing; assisted living; financial issues such as paying your bills; elderly and disability benefits; community resources; adult protective services, etc. Staff can help with completing applications for public and private benefit programs including but not limited to: Social Security, SSI, Medicare, Medicaid, etc. This is a federal/state program.

Elderly or disabled adult resident of this state (or their caregiver).

Blindness Education, Screening & Treatment (BEST)

Health and Human Services (HHS) -Health & Human Services Commission (HHSC)4900 N. Lamar Blvd.
PO Box 13247
Austin, TX 78751

TEL: 512-424-6500

Assists individuals with: diabetic retinopathy, glaucoma, detached retina, or any other eye disease determined to be an urgent medical necessity by both applicant’s doctor and DBS.

At least age 18, not legally blind, uninsured resident of Texas who: does not have resources to pay for the prescribed treatment to prevent blindness; and has been certified as having a medically urgent eye condition that poses an imminent risk of permanent/significant visual loss if not treated.

Breast and Cervical Cancer Services (BCCS)

Healthy Texas Women
1100 W 49th ST
PO Box 149021
Austin, TX 78714

TEL: 866-993-9972

Breast cancer screening for women ages 50-64; cervical cancer screening for women ages 18-64. See program website for locations of medical facilities for this program.

Women ages 18 to 64 at or below 200% of the Federal Poverty Level for size of family, and uninsured.

Children with Special Health Care Needs (CSHCN) Service Program

Health/Human Services Commission (HHSC)
4900 N Lamar BLVD -MC 1938
PO Box 149347
Austin, TX 78714

TEL: 800-252-8023

Services may include: case management, screening services, early intervention services, physical exams, hearing & vision services, nutrition services, doctor visits, lab tests, immunizations, prescription drugs, social services, home health care, etc.

Live in Texas; under age 21 (any age with Cystic Fibrosis); meets family income guidelines; and has a medical problem that: is expected to last at least 12 months, will limit 1 or more major life activities, needs more health care than what children usually need, and medical condition has physical symptoms. Contact program for details.

Children’s Health Insurance Program –

Health/Human Services Commission (HHSC)
4900 N Lamar BLVD
PO Box 149024
Austin, TX 78714

TEL: 800-647-6558

Diagnosis and evaluation; physical and occupational therapies, speech-language pathology and other health services. Evaluation/assessment, development of a family plan, case management, and interpreter services are free. Other services may have a cost share which is determined using a sliding scale based on family income.

Infants/toddlers under age 3 with developmental delays; see web site for details.

Early Childhood Intervention (ECI) Services

Health/Human Services Commission (HHSC)
4900 N Lamar BLVD
PO Box 13247
Austin, TX 78751

TEL: 512-424-6500

Specialized telephone equipment and services which provide equal access to basic telephone service for those with disabilities. See program web site for toll free numbers in: Spanish, Mandarin, Cantonese, Hmong, Vietnamese, Russian and a Spanish TTY number.

California residents who are deaf, hard of hearing, speech-disabled, cognitively-disabled, blind or diminished vision, or who have restricted mobility.

Health Information, Couseling & Advocacy Program (HICAP)

Health & Human Services Commission (HHSC)
4900 N Lamar BLVD
PO Box 13247
Austin, TX 78751

TEL: 800-252-9240

Assistance with Medicare: eligibility, enrollment, benefits; premiums, costs and claims; comparison of Part D prescription drug plans; Medigap supplemental insurance; health plan options; and programs which help pay Medicare premiums, deductibles, etc. Also, assistance with long term care options and Medicaid benefits, eligibility etc.

Residents of this state that are eligible for, or enrolled in, Medicare.

Housing Oppurtunities for People with AIDS – TX HOPWA

Health & Human Services -State Health Services
4110 Guadalupe BLDG 636
PO Box 149347 -MC 1873
Austin, TX 78714

TEL: 512-533-3000

Short-term assistance in paying rent, mortgage payments, utility payments, basic phone service and other payments essential to stable housing. Services are provided by locally funded agencies (e.g. Housing authorities, Health Departments, community-based organizations).

Resident of this state who has been diagnosed with HIV/AIDS. Applicant’s annual gross income cannot exceed 80% of the area median income; contact program for details.

iCanConnect – Texas

Mission Road Developmental Center (MRDC)
4630 Hamilton Wolfe RD
San Antonio, TX 78229

TEL: 210-929-1335

Telephones (including wireless phones); interoperable video conferencing services; access to the Internet; etc. Equipment may be hardware, software, applications, etc. Installation and training may be provided. TX has designated MRDC as the equipment provider.

Resident of this state; have a combined vision and hearing loss that causes extreme difficulty in attaining independence in daily life activities or working; household income equal to or less than 400% of the FPL. See web site for details.

Kidney Health Care (KHC)

Health/Human Services Commission (HHSC)
4900 N Lamar BLVD
PO Box 14937 MC 1938
Austin, TX 78751

TEL: 800-222-3986

Payment for covered ESRD related medical services including dialysis, payment for allowable drugs, travel for ESRD related services, and Medicaid premium payment.

Applicant must be a Texas resident with annual income of $60,000 or less, diagnosed with ESRD from a licensed physician, low income, must be receiving dialysis or have received a kidney transplant, and not eligible for Medicaid. Applicants should contact their dialysis facility or transplant center social worker for details.


Health/Human Services Commission (HHSC)
4900 N Lamar BLVD
Austin, TX 78751

TEL: 800-925-9126

Comprehensive medical care, including, but not limited to, physician visits, hospitalization, dental, emergency ambulance, lab & x-ray services etc.

A U.S. citizen or qualified alien who resides in this state and has low income, limited resources, and is included in one of the following categories: age 65 or over; families with dependent children 18 years or younger; pregnant women; disabled adults; or blind.

Medicaid for Breast & Cervical Cancer (MBCC)- Treatment

Health/Human Services Commission (HHSC)
4900 N Lamar BLVD
PO Box 13247
Austin, TX 78751

TEL: 800-252-8263

Full Medicaid benefits (comprehensive medical care) for women diagnosed with breast or cervical cancer.

Diagnosis of and in need of treatment for breast or cervical cancer, low income (see web site for details), have no insurance for this treatment, younger than 65 years, resident of Texas, and US citizen or qualified alien citizen or qualified alien.

Medicare Savings Programs (MSP) (TX)

Health and Human Services (HHS) -Health & Human Services Commission (HHSC)
4900 N Lamar BLVD
Austin, TX 78751

TEL: 512-424-6500

QMB helps pay for Part A & B premiums, deductibles, copays, and coinsurance. SLMB and QI both help pay for Part B premiums only; however, their income guidelines differ. QDWI helps pay for Part A premiums. If you qualify for QMB, SLMB or QI, you automatically qualify for another program, Extra Help, which helps pay for Medicare prescription drug coverage.

For all 4 programs: Must be enrolled in or eligible for Medicare Part A and meet assets (resources) and income guidelines. Income limits vary by program. Resource limits are the same for QMB, SLMB, and QI but differ for QDWI. For QDWI, you must be disabled. For details, see program web site.

PACE-TX- Program of All-Inclusive Care for Elderly

Health/Human Services Commission (HHSC)
4900 N Lamar BLVD
Austin, TX 78751

TEL: 800-925-9126

Primary & specialty medical care, emergency care, prescription drugs, physical therapy, adult day care etc.; i.e. all the care and services covered by Medicaid and Medicare. There are neither co-pays nor deductibles. If you are not on Medicaid, there is a premium for the long-term care portion of your care. For most enrollees, you must use PACE physicians. The program is voluntary and you can leave the program at any time.

Age 55 years or older who: require a “nursing facility level of care”; must be able to live safely in the community at the time of initial enrollment; and live in the service area of a PACE organization. You can be on Medicaid or Medicare or both; if you are in neither program, you may private pay. Note: “nursing facility level of care” is defined by the State’s Medicaid office.

Specialized Telecommunications Assistance Program (STAP)

Health/Human Services -Health/Human Services Commission -Deaf/Hard of Hearing Services
4900 N Lamar BLVD
PO Box 13247
Austin, TX 78751

TEL: 800-628-5115

Telecommunications devices such as captioned phones, light flashing ring signalers, TTYs, amplified telephones, loud ringers, hands free speakerphones etc.

Residents of Texas with disabilities that interfere with access to the telephone.

Texas HIV Medication Program -THMP 

HIV/STD Program
4110 Guadalupe BLDG 636
PO Box 149347 MC 1873
Austin, TX 78751

TEL: 800-255-1090

Covers a long list of FDA approved HIV/AIDS related medications.

Texas resident who must: be diagnosed as HIV-positive; meet income guidelines (200% of Federal Poverty Level); and is uninsured or underinsured.

Texas Technology Access Program (TTAP)

UT Austin -Center for Disability Studies
10100 Burnet Road -Commons Learning CTR
STE 1.154
Austin, TX 78758

TEL: 800-828-7839

Examples of AT include (but not limited to): wheelchairs/motorized scooters; hearing aids; computers; home modifications (grab bars, ramps, widened doorways, etc.); communication aids; etc. Texas has designated the University of Texas-Austin to deliver AT services under this federal/state program.

Resident of this state; physically or mentally disabled.

Texas Vaccines for Children Program (TVFC) 

Health/Human Services -Immunizations
1100 W 49th ST
Austin, TX 78756

TEL: 800-252-9152

Diseases preventable by vaccines include: Diphtheria, hepatitis, influenza, measles, pneumococcal, mumps pertussis, polio, tetanus etc. A small administrative fee (amount regulated by State) may be charged; also an office visit charge may be applicable.

Children thru age 18 who meet one of the following criteria: child is Medicaid eligible; or uninsured; or American Indian or Alaska Native; or qualifying underinsured.

Vaccines for Children Program (VFC) – San Antonio

Metropolitan Health District
111 Soledad (Administration, No services)
STE 1000
San Antonio, TX 78205

TEL: 210-207-3965

Diseases preventable by vaccines include: Diphtheria, hepatitis, influenza, measles, pneumococcal, mumps pertussis, polio, tetanus etc. A small administrative fee (amount regulated by State) may be charged; also an office visit charge may be applicable.

Children thru age 18 who meet one of the following criteria: child is Medicaid eligible; or uninsured; or American Indian or Alaska Native; or qualifying underinsured.

Women Infants & Children’s Program (WIC) (TX)

Health & Human Services
1100 W 49th St
PO Box 149347 Mail Code 1933
Austin, TX 78714

TEL: 800-942-3678

Provides the following at no cost: health screening at initial appointment for all applying family members; nutritional foods; nutrition education; help finding health care; breast-feeding support etc.

Low income and nutritionally at risk; resident of this state; and are one of the following: pregnant, breast-feeding a baby under age 1, just had a baby, or have an infant or child under the age or 5. See web site for details.

Health Insurance By County

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