Health insurance for Texans is becoming increasingly expensive and has fewer options for participating doctors and hospitals. It may also require more out of pocket than it did in 2016. I know. I received my renewal packet and my rate starting in December will be 29% higher than what I’m paying now. The exchange opens on Tuesday, November 1st so here’s an overview of what’s coming. Keep in mind the numbers expressed here are based on me buying an individual policy and living in Dallas County. Your rates will be different and are determined by your age, county, projected income, and the answers you give to the underwriting questions.
By the Numbers: Here’s a summary of what’s available to me, if I were to pick a plan off the exchange.
- There are 32 plans available to me on the government exchange
- These plans are offered by 3 providers, Molina, Ambetter by Superior, and Blue Cross and Blue Shield of Texas (BCBS)
- 2 are HMO only (Molina & BCBS) 1 offers an EPO (Ambetter)
- Each company provides multiple options in the 3 plan categories, Bronze, Silver, and Gold
- Monthly premium ranges from $472.99 to $1,203.18
- Deductibles range from $0 to $7,050
- Copayments range from no charge to 50% and some copayments continue even after the deductible is met
- Out of pocket maximum starts at $3,500 and tops out at $7,150
When comparing options, here are 5 things to consider, aside from the monthly premium, before finalizing your decision.
Plan Type: The two plan types offered on this year’s exchange are HMO and EPO. Health Maintenance Organization plans mean you pick one primary physician or group and all your care services go through that doctor or group. You must obtain a referral from your primary care physician or group to see a specialist or other professional. There may be limited coverage for out of network services.
Exclusive Provider Organization, or EPO, provides health care within a limited network of doctors and hospitals. There are no benefits, or coverage, if you go out of network for any reason. If you travel a lot, this is not your plan.
Coinsurance: This is the amount you’ll pay after you’ve met your deductible. It’s usually expressed as a percentage such as 0%, 10%, 20%, etc. The higher the percentage, the more you pay out of pocket for your health care, whether it’s an exam, medication, or surgery. Find out what coinsurance applies after the deductible is met.
Copayments: This is an amount you’ll pay in addition to whatever the health insurance plan pays. It’s usually expressed in a dollar amount, such as $20 for an office visit, $15 to fill a prescription, etc. even after the deductible is met.
Deductible: This is the amount you pay out of pocket before the health insurance plan pays for any health care services. Usually, a lower deductible will correspond with a higher monthly premium while a higher deductible will yield a lower monthly rate. There are usually two sets of deductibles; one for individuals and one for families. If you’re buying for the family, review both deductibles to determine your maximum out of pocket cost.
Out of Pocket Maximum: This the maximum amount you’ll pay in any one plan year for health care services. While copayments, and in some cases, coinsurance, may continue after this has been met, that should be the only additional payment you make.
There are a lot of moving parts to consider when buying health insurance. I recommend reviewing the plans now and comparing multiple plans to determine your true cost of ownership beyond the monthly premium. I also suggest seeking the help of a licensed health insurance agent to compare plans on the exchange to off exchange plans offered by these and other insurance companies to find the best one for you and your budget.
What do you think? Share your comments, questions, and experiences with me on my Facebook, Google + and LinkedIn pages. I’d love to hear from you!