Low-Cost Health Insurance in Texas: Our Top Picks

Health insurance costs in Texas challenge many residents, with around 4.9 million people uninsured, leading to potential out-of-pocket medical expenses and limited access to care.

Affordable coverage options are available, such as employer-sponsored plans, marketplace offerings, and government programs.

This article reviews these options, outlining top low-cost plans and providing tips for choosing the right coverage.

Health Insurance Options in Texas

Texas residents have various health insurance options. For employed, self-employed, or seeking family coverage, choices include employer-sponsored plans and individual health insurance through the marketplace, offering options at different affordability levels.

1. Employer-Sponsored Health Insurance

If your employer offers health insurance, this can be a cost-effective way to access coverage, as employers often pay part of the premium. Even if you lose your job, you may still be able to stay on the plan through COBRA.

2. Individual and Marketplace Plans

Texans without employer-sponsored insurance can explore individual health plans through the Health Insurance Marketplace. These plans, offered by private insurers or HMOs, are accessible on healthcare.gov or with help from an approved Navigator for enrollment.

The marketplace categorizes plans into metal tiers, differing coverage, and out-of-pocket costs. Options range from higher-coverage plans like Silver and Gold to more budget-friendly choices like Bronze.

Metal Tiers and Plan Coverage

Marketplace health insurance plans come in four categories:

• Bronze Plan: Covers 60% of healthcare expenses, with enrollees paying the remaining 40% through deductibles, copayments, coinsurance, and other out-of-pocket costs.
• Silver Plan: Covers about 70% of medical costs, offering a middle ground between premiums and out-of-pocket expenses. It qualifies for cost-sharing reductions (CSR) for eligible lower-income individuals, lowering out-of-pocket costs.
• Gold Plan: Covers around 80% of healthcare costs, featuring higher premiums with lower out-of-pocket expenses.
• Platinum Plan: This covers 90% of medical expenses, carrying the highest premiums but offering the lowest out-of-pocket costs.

Affordable Health Insurance Options in Texas

Texas offers various affordable healthcare options through government programs, alternative plans, and the Health Insurance Marketplace, aiming to give residents access to necessary medical care without heavy out-of-pocket expenses.

1. Government Programs for Low-Income Individuals

Texas offers Medicaid to limited-income residents and the Children's Health Insurance Program (CHIP). Medicaid covers low-income individuals, including pregnant women, seniors over 65, and those with disabilities. CHIP provides low-cost coverage for children in families who don’t qualify for Medicaid but can’t afford private insurance.

Eligibility for Medicaid is based on income, adjusted yearly—for example, individuals may qualify with an annual income of $25,503 or less. Children under age 18 may qualify for CHIP, with income limits depending on household size.

2. Health Marketplace Plans and Premium Assistance

For those not eligible for government programs, the Health Insurance Marketplace provides affordable options through private insurers, accessible on healthcare.gov. Bronze and Silver plans are among the more affordable, offering lower premiums but higher out-of-pocket costs.

Subsidies can help reduce costs for eligible individuals. A premium tax credit is available for those earning between 100% and 400% of the Federal Poverty Level (FPL), significantly lowering monthly premiums. When selecting a Silver plan, additional savings on deductibles, copayments, and coinsurance are possible through cost-sharing reductions (CSRs).

3. Alternative Health Plans

Some individuals choose alternative health plans, often with lower premiums but certain restrictions. These include short-term, limited-benefit, and healthcare-sharing ministries that don’t adhere to Affordable Care Act (ACA) regulations.

• Short-Term Health Plans: These last up to 12 months and may be renewed for three years. Although premiums are lower, they generally exclude coverage for pre-existing conditions and preventive care.
• Limited-Benefit Plans: These plans focus on specific services, like accident or disease-related care, offering limited coverage with potentially high out-of-pocket costs.
• Health Care Sharing Ministries: Nonprofit organizations that pool members' funds for medical expenses, offering lower fees but limited coverage without state regulation or guaranteed coverage for all conditions.

Alternative health plans may appear cost-effective, but their coverage details often reveal limitations. These plans typically exclude pre-existing conditions, impose waiting periods, and lack access to federal subsidies, including tax credits and cost-sharing reductions.

Low-Cost Health Insurance in Texas

Here are some of the top low-cost options outlined and selected for their affordability, coverage, and value.

1. Blue Cross Blue Shield

The MyBlue Health Silver 405 plan from Blue Cross Blue Shield is an option for Texans, offering a $1,000 out-of-pocket maximum for those eligible for cost-sharing reductions. Priced at $475 per month, it covers medical services and prescriptions, including preventive care, mental health services, and specialist visits with affordable copays.

This plan suits low-income individuals, combining cost-sharing reductions with access to Blue Cross Blue Shield’s network of providers.

2. Baylor Scott & White Health Plan

The BSW Vital Bronze HMO 007 from Baylor Scott & White Health Plan offers an affordable Bronze plan option at $335.87 per month, with a deductible of $7,500 and an out-of-pocket maximum of $9,400. It covers primary care, specialist visits, and urgent care, making it suitable for healthy individuals seeking preventive care and occasional visits.

This plan has higher out-of-pocket costs than Silver plans but provides one of the most budget-friendly options within the Baylor Scott & White network.

3. Ambetter

Ambetter from Superior Health Plan provides the Ambetter Standard Silver plan at $438 per month for residents in Houston and nearby areas. This plan suits those with moderate medical expenses, balancing premium and out-of-pocket expenses.

It offers a broad provider network and covers essential health services, including preventive care, prescription drugs, and specialist visits.

Finding the Right Low-Cost Health Insurance for You

The range of available plans allows for a mix of premiums, deductibles, and out-of-pocket costs suited to individual or family needs. Considering personal circumstances and comparing options provides a clearer view of the best fit.

1. Consider Your Health Care Needs

A Bronze plan with lower premiums and higher out-of-pocket costs may work well for generally healthy individuals who don't anticipate heavy medical usage. Plans like the BSW Vital Bronze HMO 007, at $335.87 per month, provide affordable coverage primarily for preventive services.

Those with ongoing healthcare needs or expected medical usage may find better value in a Silver plan. Silver options, like the MyBlue Health Silver 405 from Blue Cross Blue Shield, balance premiums with out-of-pocket expenses and offer additional savings for those who qualify for CSR.

2. Understand Your Financial Situation

Eligibility for premium tax credits or cost-sharing reductions can lower monthly premiums and out-of-pocket costs. For example, individuals earning between $14,580 and $21,870 annually may see reduced costs on Silver plans, such as Community Select Silver 019 or MyBlue Health Silver 405.

Without these reductions, a Bronze plan may better suit those looking to keep monthly expenses low. The MyBlue Health Bronze 402 offers a premium of $321.96 per month.

3. Consider Long-Term Needs and Future Health

A comprehensive plan like Gold or Silver may offer more security for those anticipating increasing healthcare needs or seeking stable coverage as they age.

The Ambetter Standard Silver plan from Ambetter suits individuals expecting moderate medical expenses, balancing out-of-pocket costs with monthly premiums. Silver plans generally provide more robust support for chronic conditions and ongoing care needs.

Final Words

Texans have multiple options for healthcare coverage, from employer-sponsored plans to marketplace options and government programs, each suited to different budgets and healthcare needs. Consider the types of coverage available, such as Bronze, Silver, Gold, and Platinum plans, as well as government programs like Medicaid and CHIP.

FAQs on Low-Cost Health Insurance in Texas

How do I qualify for Medicaid in Texas?

Medicaid is available to low-income individuals who are either pregnant, under 18, disabled, or aged 65 and older.

What if I miss the open enrollment period?

If you miss Open Enrollment, you can only enroll or change Marketplace plans if you qualify for a Special Enrollment Period. These are triggered by specific life changes within the past 60 days, such as marriage, having a baby, losing health insurance due to divorce, or death of someone on your plan. Each event has its own enrollment rules and coverage start dates.

How often can I change my health insurance plan in Texas?

In Texas, Medicaid enrollees can change plans anytime, CHIP members within 90 days of enrollment, and CHIP Perinatal members within 120 days. Changes take 15-45 days and can be made by phone or online through Your Texas Benefits.