If you’re uninsured, you’re not alone.  Millions of Americans are without health insurance, whether they lost it when they lost their job, are self-employed and must cover their own benefits or simply haven’t found the right plan yet. Finding and choosing Texas health insurance plans can be difficult if you don’t know where to start.

Since Texas health insurance rates are regulated by the state government, those interested in purchasing health insurance should focus on more than just price.  Pay close attention to the following items when choosing a Texas health insurance plan to ensure you’re getting the plan that best suits your needs.

Covered services – What medical services are covered?  Depending on your health and health care needs, look for policies regarding annual checkups, immunizations, maternity benefits and whether vision and dental insurance are included or covered under a separate policy.  Another important consideration is whether specialist services are covered, including chiropractic care, acupuncture and physical therapy.

Deductible – A deductible refers to the amount an individual must pay for health care expenses before insurance starts to help cover the costs.  Those requiring frequent doctor visits and prescriptions might benefit from a plan with a small deductible; other individuals might opt to pay out-of-pocket for their infrequent doctor visits and instead pair a Health Savings Account with a high-deductible health plan to cover them in case of emergencies or catastrophic events.

Co-payments – Co-payments are predetermined flat fees that one pays for health care services, in addition to what their insurance covers.  Co-payments often kick in once a deductible is reached, and different costs may be applied when seeing a primary care physician versus a specialist, and when filling prescriptions.

Co-insurance – Similar to a co-payment, co-insurance refers to money that an individual is required to pay for services.  But rather than a flat fee co-payment, co-insurance is a percentage that an individual must pay toward a particular service.  For example, an individual could pay 20 percent of prescription costs, while the insurance company picks up the remaining 80 percent.  Depending on your needs and the amount you’re required to pay for services, calculate whether co-insurance or a co-payment is the best option for you.

Network of providers – Is your doctor covered under your insurance policy?  If not, you may have to pay more to see your “out-of-network” physician.  If you have a favorite doctor, or see a particular doctor regularly, make sure he or she is covered by your insurance.  Contact prospective insurance providers for a list of covered doctors, or simply ask your doctor if he accepts your insurance.

Pre-existing conditions – When choosing a health insurance plan or receiving a Texas health insurance quote, it’s important to know if the plan covers health problems you already have. Often a medical condition will be excluded from coverage by an insurance company if the condition existed prior to your obtaining benefits.  Ask potential health insurance carriers their policies regarding pre-existing conditions to ensure you’re covered.

This entry was posted on Thursday, December 24th, 2009 at 9:54 am and is filed under Individual Health Insurance, Self-Employed Health Insurance, Texas health insurance. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.