Dallas, TX Individual Health Insurance
When shopping for affordable health insurance in Dallas TX, the Thumann Agency is here to help! We can find a health insurance policy that makes sense for your family and your budget. As an independent insurance agency, we specialize in customized, individual health insurance. Our experienced agents can compare plans from multiple companies to find the best policy that fits you with rates you can afford.
Health Insurance options Dallas, Texas
In Texas, there are essentially two types of Individual Health Insurance plans: Indemnity plans (fee-for-services) or Managed Care plans. The differences between the two include your choice of providers, out-of-pocket expenses for your covered services and how your medical bills are paid.
Depending on you and your family’s health care needs, one plan may be a better fit over another. It is important to remember that no one plan will pay for all the costs associated with your medical care. Our experienced health insurance agents can help you determine which plan has the best coverage for your needs.
You should have a basic understanding of the different types of Individual Health Insurance plans available to you in Texas. They include Indemnity Plans, Managed Care Options and Government-Sponsored Health Insurance.
A. Indemnity Plans
Cafeteria or Flexible Spending Plans are employer-sponsored insurance plans that allow the employee to design his or her own employee benefits package. Employees can typically choose between one or more employee benefits and cash. Several types of Flexible Spending Plans are used by employers. These include pre-tax conversion plans, multiple option pre-tax conversion plans, medical plans plus flexible spending accounts, and employee credit cafeteria plans. For more information about which of these would be the best fit for you, contact your employee benefits department.
Indemnity Health Plans allow you to choose your health care providers. You can go to any doctor, hospital or other medical providers for a set monthly premium. This type of plan reimburses you or your health care provider by services rendered. You may be required to meet a deductible and pay a percentage of each bill. However, there is also often an annual limit on out-of-pocket expenses. This means that once an individual or family reach their limit, the insurance policy covers the remaining eligible medical expenses in full. Indemnity Health Plans sometimes impose restrictions on covered services and may require prior authorization for hospital care or other expensive services.
“Basic and Essential” Health Plans provide limited health insurance benefits at a considerably lower cost. When buying this type of plan, it is extremely important to read the policy description carefully. Most basic plans don’t cover certain types of treatments, such as chemotherapy, certain types of prescriptions, and maternity care. Rates can vary considerably with Basic or Essential Health Plans because premiums are community-rated and are based on age, gender, health status, occupation, and geographic location.
Health Savings Accounts (HSA) are a recent alternative to traditional health insurance plans. HSAs are a savings product designed to offer individuals a different way to pay for their health care. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis. Instead of paying a traditional premium, you establish a tax-free savings account that covers your out-of-pocket medical expenses. This means that you own and control the money in your HSA. You make all of the decisions about how to spend your money without relying on a third party or a health insurance company. You can also decide what types of investments to make with the money in your account. You should be aware that if you sign up for an HSA, you are required to buy a High Deductible Health Plan as well.
High-Deductible Health Plans (HDHP) are sometimes referred to as “catastrophic health insurance coverage”. An HDHP is an inexpensive health insurance plan that kicks in only after a high deductible is met of at least $1,000 for an individual or $2,000 for a family.
B. Managed Care Options
Health Maintenance Organizations (HMOs) offer access to an extensive network of participating physicians, hospitals and other health care professionals and facilities. You choose a primary care doctor from a list provided by the HMO and this doctor coordinates your health care. You must contact your primary care doctor to be referred to a specialist. Generally, you pay fewer out-of-pocket expenses with an HMO, but you are often charged a fee or co-payment for services such as doctor visits or prescriptions.
Point-of-Service (POS) plans are an indemnity-type option in which the primary care doctors in the POS plan usually make referrals to other providers within the plan. If a doctor makes a referral out of the plan, the plan pays all or most of the bill. However, if you refer yourself to an outside provider, the service is covered by the plan, but you will be required to pay co-insurance.
Preferred Provider Organizations (PPO) charge on a fee-for-service basis. The participating doctors, hospitals, and health care providers are paid by the insurer on a negotiated, discounted fee schedule. Costs are lower if you use in-network healthcare services, but you have the option of going out-of-network. If you choose an out-of-network provider, you are generally required to pay the difference between what the provider charges and what the plan pays.
C. Government-sponsored Health Insurance
Medicaid is a federal/state public assistance program created in 1965. It is administered by the states for people whose income and resources are insufficient to pay for health care or private insurance. All states have Medicaid programs, though eligibility levels and coverage benefits vary.
Medicare is a federal government program for people 65 and older, or those with certain disabilities that pays part of the costs associated with hospitalization, surgery, doctors’ bills, home health care, and skilled-nursing care.
State Children’s Health Insurance Program (SCHIP) is administered at the state level and provides health care to low-income children whose parents do not qualify for Medicaid. SCHIP may be known by different names in different states.
Military Health Care includes TRICARE/CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) as well as care provided by the Department of Veterans Affairs (VA).
State-specific Plans are available for low-income uninsured individuals. These plans are known by different names in different states.
Indian Health Service (IHS) is a Department of Health and Human Services program offering medical assistance to eligible American Indians at HIS facilities. In addition, the HIS helps pay the cost of selected health care services provided at non-HIS facilities.
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