Shop Affordable Texas PPO Plans in all 254 Counties
Are you shopping for a Texas PPO plan? Are you looking to better understand the Texas PPO health insurance market and compare TX PPO rates? Here you will find key resources needed to help you make an informed decision on selecting the right Texas PPO plan
Texas PPO Insurance Carriers
Texas PPO Insurance CarriersBelow is the list of carriers that currently offer Texas PPO health insurance plans for sale in 2022 for Small Businesses. Only certain carriers offer PPO plans to employed individuals, Freelancers, and the Self Employed. Please call for the latest carrier information.
- Aetna
- Ambetter
- Blue Cross Blue Shield of Texas
- Cigna
- CHRISTUS
- FirstCare Health Plans
- Humana
- Molina HealthCare
- Oscar Health Insurance Plan
- Scott & White Health Plan
- United HealthCare of Texas
What Everyone Should Consider Before Buying a Texas PPO Health Plan
Are Your Doctors In-Network – While the purpose of a PPO is to allow you the freedom to go to non-network providers, it’s always a good idea to see if your current physicians are part of the network. If not, it just means that when you do visit those doctors for care, you will be charged an out-of-network rate, even though as we said, TX PPO plans will cover out-of-network services
Most people would prefer to call their doctor’s office and ask the first person that picks up the phone. Don’t just ask the doctor’s office whether they’re a participating provider of certain insurance plans before enrolling. 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. With a TX PPO health plan, any of your out-of-network medical services will go towards your out-of-network deductible
Lower Monthly Premium Can Result in Higher Costs– Most often in life, we find that the less you spend on a product the more costly it is to use that product. Health insurance follows that same principle. Payless now and expect to pay more later when you use the insurance. The most sensible way of approaching the pay more now pay less later vs the pay less now and more later is to consider your current health conditions and family history.
If you’re in good physical health and don’t t foresee high costing health-related issues and you’re not one to use prescriptions on a very regular basis, then maybe choosing a lower costing health insurance plan is a better option for you. If you do foresee high medical expenses and prescription usages then it may be more cost-effective to purchase a plan that costs more per month. Always consider your health and family history when shopping for a Texas PPO health insurance plan.
Health Insurance is a Contract – Like all contracts once signed they are enforceable and you have agreed to the terms of the contract. If for some reason you find that you’re no longer happy with your TX PPO Insurance plan, you can’t go back mid-year to the carrier and request a policy change. Rather than getting into that unfortunate situation, request a summary of benefits and ask questions before starting a plan. The only time the above doesn’t apply is if you’re employed and lose coverage. You can then go to your state marketplace and purchase individual health insurance plans. Unfortunately, there aren’t any TX PPO plans that are sold on-exchange
Types of Insurance Coverage – HMO, PPO, POS, EPO, HDHP, and HSA are different health plan designs. The first four are the most common. They are modeled after the old standard insurance plans originating with the national BlueCross and Kaiser plans. These plan models differ by allowing you to see specialists with or without needing referral and receive out-of-network and out-of-state care. Also, different plans have different rules regarding the need for referrals. If you’re often seeing medical specialists that arent part of the plan network then you should consider a plan that offers greater flexibility such as a TX PPO plan.
If you’re a traveler and live in multiple states per year, then you should consider a Texas PPO plan, It offers that multi-state flexibility. 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.
Are Essential Health Benefits Covered? – All Texas PPO plans should cover the 10 essential health benefits, which provide those insured with a guaranteed minimum level of coverage. That is the standard and hallmark set by the Affordable Care Act. Why would anyone need a minimum standard level? Well, the cost of receiving medical treatment is so high that without insurance it can and does often lead to financial ruin. By guaranteeing a plan includes the 10 minimum essential health benefits, it provides you with what the basis of a health insurance policy was designed to do, and that is to make the insured whole again
Texas PPO Rates for 2022
Texas PPO Rates for 2022The table below includes 6 Texas PPO options with approximate rates, office copays, deductibles, and prescription benefits Be sure to call our office at the number listed above for full plan information
| Cigna Elite PPO Advantage 5000 | Cigna Elite PPO Silver 3000 | Cigna Elite PPO 1000 | |
|---|---|---|---|
| National | National | National | |
| In-Network Benefits | Cigna PPO OAP Network | Cigna PPO OAP Network | Cigna PPO OAP Network |
| Office Co-pay | $20 | $40 | $30 |
| Specialist Co-pay | $60 | $60 | $50 |
| Rx: Generic/Brand/High Brand | $0/25%/50% after deductible | $0/25%/50% | $0/25%/50% |
| Emergency Room | 30% after deductible | 30% after deductible | 20% after deductible |
| Hospital Co-pay | 30% after deductible | 30% after deductible | 20% after deductible |
| Referrals Needed | No | No | No |
| In-Network Deductible (single/family) | $5,000/$10,000 | $3,000/$6,000 | $1,000/$2,000 |
| Max Out of Pocket (single/family) | $8,150/$16,300 | $8,150/$16,300 | $8,150/$16,300 |
| In-Network Co-Insurance | 30% | 30% | 20% |
| Out-of-Network Benefits | |||
| Deductible | $10,000/$20,000 | $6,000/$12,000 | 6,000/$12,000 |
| Out of Pocket Max (single/family) | Unlimited | Unlimited | Unlimited |
| Co-Insurance | 50% | 40% | 50% |
| Other Benefits | |||
| Vision/Dental | Pediatric Vision and Dental | Pediatric Vision and Dental | Pediatric Vision and Dental |
| Mental/Substance | 30% after deductible | 30% after deductible | $50 |
| Renewal Date | 12/31/2022 | 12/31/2022 | 12/31/2022 |
| Premium | |||
| Single | $735.00 | $905.00 | $1,285.00 |
| Couple | $1,400.00 | $1,790.00 | $2,635.00 |
| E+child | $1,213.00 | $1,520.00 | $2,2215 |
| Family | $1,743.00 | $2,225.00 | $3,305.00 |
| Summary of Benefits | Cigna Elite PPO Advantage 5000 | Cigna Elite PPO Silver 3000 | Cigna Elite PPO 1000 |
Most Common Questions Regarding a Texas PPO Health Plan
Most Common Questions Regarding a Texas PPO Health PlanHow much does a Texas PPO cost?
Texas PPO Health plans are almost always more expensive than other plan types, due to the flexibility that PPO plans provide. Use the table above to see TX PPO rates and call for additional information
Does my doctor accept Texas PPO Insurance?
be sure to use the list of health insurance companies included above and locate your company. Once in their network directory, check to see if they have a PPO section. Additionally, it’s a great idea to call your doctors office and speak with the office manager, share with her the company name and plan name
Where can I buy a Texas PPO health insurance plan?
Brokers are the most common resource when it comes to TX PPO Health plans. Not only can they assist in comparing and purchasing a health plan, but they are also expected to help during the plan year with such problematic issues as claims, payments, and any other problems that might exist
How do I qualify for a TX PPO plan?
To qualify for a TX PPO plan, the person applying must either be employed, self-employed or a freelancer.
Can I buy a TX PPO plan anytime?
Y. Yes, Texas PPO plans have a 1st of the month start date and as long as you have the paperwork in by the 15th of the prior month, then it shouldn’t be a problem to get that 1st of the month effective date. That applies throughout the year as well
What happens if I’m not satisfied with my TX PPO health plan, can I change it?
You did sign a contract and as such, you cannot change your health plan until your PPO is up for renewal. Health contracts often start at the beginning of the year and run until the end of the year. This may not be the case for your specific contract so contact your broker to see if you can change your plan and what the renewal date is. You do have one option and that is to select a different company that sells TX PPO plans and start a new plan, check with the company first before making any changes
What makes a PPO plan special?
Larger networks, Better doctors, top tier hospitals, out-of-state usage are the most common advantages to a TX PPO Plan. These are the strongest reasons why persons with compromised health issues, seniors, and those wanting flexibility tend to choose PPO plan options.
Must I be self-employed or part of a group to buy a PPO plan?
There two traditional ways of having access to a TX PPO health plan are, being an employee of a company that has a PPO plan. the second is for freelancers and sole proprietors to become part of an association that is offering a PPO. Working individuals may also qualify under certain conditions.
Can I Buy a Texas PPO Health insurance plan through healthcare.gov?
Not for Individual health coverage, Your closest option is an EPO and that doesn’t offer you the most important aspect of a PPO which is out-of-network usage. HMO plans are also offered on the Federal Exchange and many State Exchanges. For a small business, yes PPO options are available, though they are limited.
Do freelancers qualify for TX PPO plans?
Not as much as they used to. That’s not a very direct answer but since the creation of the affordable care act, a freelancer is now considered an individual. To purchase a PPO plan, you would need to join an association that offers Texas PPO plans.
Can seniors age 65 and above qualify for a PPO plan?
If you’re 65 and above and employed and the company contracts with a PPO plan then yes, as long as you remain employed you can opt to continue with that plan and choose not to be covered under medicare. Be sure to check with your company because there are rules relative to company size. Those that are 65 and older that are not employed would not qualify for a TX PP Plan
Can PPO plans be offered for sale as short term medical plans?
Yes. Short term plans contract with PPO networks, like Cigna, Aetna, and Unitedhealthcare. Unfortunately, most of those short term plans don’t cover you for the 10 essential health benefits and that means they’re not true health insurance plans Be sure to always check the summary of benefits before signing up for a plan
What makes a PPO plan a more expensive health plan as compared to other types of plans like HMOs?
It always comes down to what a plan offers that drives the overall cost of the plan. For a PPO plan, it’s being able to go out of network on a national level. Not all hospitals are created equal and for someone who has a medical condition that requires a serious and complicated procedure, that person would likely choose the best hospital and providers that can best take care of that procedure.
I see that there are a larger number of hospitals and doctors in PPO plans, why is that?
PPO plans are contracts and the insurance companies that create and manage these PPO plans pay certain doctors and hospitals above average rates to participate in their PPO plan. Those same hospitals and doctors are considered to be at the top of their field and don’t accept reimbursement rates that aren’t in line with their skill sets and capabilities, meaning they won’t accept the reimbursement levels of such plans like HMOs and EPOs