Consider the following statistics about health care coverage in Texas*
Total Texas Residents: 27,677,200
Total Texas Uninsured Residents: 15%
Total Texas HMO Enrollment: 5,322,720
Avg Annual employee premium in TX employer-sponsored plan (after employer contribution): $1,197
Avg Texas hospital cost per inpatient day (before insurance): $2,292
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Health insurance helps you pay for medical services. Once you purchase insurance coverage, you and your health insurer each agree to pay a part of your medical expenses–usually a certain dollar amount or percentage of the expenses.
When buying health insurance, your choices typically fall into one of three categories:
Traditional fee-for-service health insurance plans are usually the most expensive choice, but they offer you the most flexibility in choosing health care providers.
Health maintenance organizations (HMOs) offer lower co-payments and cover the costs of more preventive care, but your choice of health care providers is limited to those who are part of the plan.
Preferred provider organizations (PPOs) offer lower co-payments like HMOs but give you more flexibility in selecting a provider.
As your specific needs are individual to you, buy the health insurance that makes the most sense for you and your needs.
Speak to one of our licensed health insurance agents and ask questions, such as:
Do I have the right to go to any doctor, hospital, clinic, or pharmacy I choose?
What is the most I will have to pay out of my own pocket to cover expenses?
Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
The more questions you ask, the more informed you’ll be. Working with an experienced agent will make the difference between coverage that just works, and coverage that meets your needs.
A service that helps people shop for and enroll in affordable health insurance. The federal government operates the Marketplace, available at Healthcare.gov, for most states. Some states run their own Marketplaces.
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families the right to choose to continue group health coverage provided by their group health plan for limited periods of time. There are three basic requirements that must be met for you to be entitled to elect COBRA continuation coverage:
Your group health plan must be covered by COBRA
A qualifying event must occur (for example, voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, or divorce)
You must be a qualified beneficiary for that event
If you are entitled to elect COBRA continuation coverage, you must be given an election period of at least 60 days to choose whether or not to elect continuation coverage.
Under COBRA, group health plans must provide covered employees and their families with a notice explaining their COBRA rights. Plans must also have rules for how COBRA continuation coverage is offered, how qualified beneficiaries may elect continuation coverage, and when it can be terminated. COBRA is usually more expensive and the consumer could take on additional fees associated with this type of coverage.
Long-term care (LTC) is a variety of services that include medical and non-medical care for people who have chronic illnesses or disabilities. Most health insurance plans and Medicare severely limit or exclude long-term care. If you want coverage, you may need a separate long-term care insurance policy. You should consider the cost of long-term care insurance as you plan for retirement. These questions can help you evaluate long-term care insurance policies.
What qualifies you for benefits?
Some insurers say you must be unable to perform a specific number of the following activities of daily living: eating, walking, getting from bed to a chair, dressing, bathing, using a toilet, and remaining continent.
What type of care is covered?
Does the policy cover nursing home care? What about coverage for assisted living facilities that provide less client care than a nursing home? If you want to stay in your home, will it pay for care provided by visiting nurses and therapists? What about help with food preparation and housecleaning?
What will the benefits amount be?
Most plans are written to provide a specific dollar benefit per day. The benefit for home care is usually about half the nursing-home benefit. But some policies pay the same for both forms of care. Other plans pay only for your actual expenses.
What is the benefits period?
It is possible to get a policy with lifetime benefits but this can be very expensive. Other options for coverage are from one to six years. The average nursing home stay is about 2.5 years.
Is the benefit adjusted for inflation?
If you buy a policy prior to age 60, you face the risk that a fixed daily benefit will not be enough by the time you need it.
Is there a waiting period before benefits begin?
A 20 to 100 day period is not unusual.