Health Insurance in Houston: A Detailed Note on Available Options

Updated: November 9, 2022
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Finding a plan that strikes a mix between affordable premiums and sufficient coverage can be difficult while navigating this market. Less expensive plans, or that charge lower premiums, typically have larger deductibles & out-of-pocket maximums. These plans cost less each month, but they only cover a portion of your medical costs. Let us discuss more about health insurance in Houston.

You must purchase private healthcare insurance through the Houston insurance exchange if you cannot obtain coverage through your company or employer, a government program, such as Medicare (if you are 65 or older), or Medicaid.

To make it simpler to locate insurance that meets your needs, we recognized the top marketplace plans in Houston based on age, coverage level, and other considerations.

 

Family and Individual Health Plan in Houston, Texas

You might be a candidate for a new private health insurance plan in Houston if:

  • You work for yourself.
  • Your employer provides no group insurance
  • You are enrolled in a group plan; it does not provide spouse or dependents coverage.
  • You are a health plan member; the premiums are too expensive.
  • You are a health plan member, and your benefit requirements have changed.

 

Finding inexpensive Individual & Family Health Insurance in Houston

If you and your spouse or domestic partner are looking for a new health insurance plan, we advise you to compare health insurance quotes jointly and separately to find the most affordable option.

Depending on the health insurance provider, individual and family health insurance premiums for couples in Houston may be determined by the age of the youngest person covered by the policy. When applying for the same plan jointly instead of separately, some couples with a significant age difference may discover they save money. Couples with a small age gap can reduce their total expenditures by enrolling in separate health insurance plans. If you and your partner enroll in a health insurance plan, ensure that the plan includes all the features you need.

 

Children’s health insurance plans in Houston

By covering the cost of monthly checks and medical visits, health insurance enables you to keep your kids healthy. Additionally, it covers their medical expenses should they become ill or hurt. There are various ways to get your kids health insurance:

  • If your workplace provides a health plan through your work-related insurance.
  • From a health maintenance group or an insurance provider (HMO).
  • If you are eligible, through Children’s Medicaid or the Children’s Health Insurance Program (CHIP).

 

Obtain a plan via your employment

Your children can typically be added to your plan as a “dependent” if you have health insurance via your employer. Up until the age of 26, you can continue to enroll your kids in your health plan. Even if they are married, they might still be covered by your plan. However, you cannot include their spouses.

If you list your grandchildren as a dependent on your tax return, you can include them in your plan. They are eligible to remain on your plan until they are 25.

 

Get your own policy

You can purchase insurance from an insurance company if your employer doesn’t offer a health plan or if you want greater coverage. There are many different kinds of plans. You can choose a package to cover your entire family or just your child. A business cannot refuse to sell you a plan due to health issues, such as a disability or previous condition.

Visit HealthCare.gov or dial 800-318-2596 to shop for insurance through the federal marketplace. If you buy health insurance through the exchange, you may qualify for financial assistance as a subsidy.

Purchasing a health plan might be difficult due to the abundance of options. Companies have representatives who can assist in addressing your inquiries regarding their strategies. You can also check health insurance in Texas to get an affordable plan.

 

Obtain a Children’s Medicaid or CHIP plan.

Children’s Medicaid or the Children’s Health Insurance Program may be able to provide low-cost or free health insurance to children in Houston (CHIP). Both plans include medical visits, prescription medications, dental work, eye tests, glasses, and other services.

The cost of receiving Children’s Medicaid is nothing. Families who are covered by CHIP pay less than $50 annually. Copays are required for several health services. You must pay a copay every time you receive a service, such as visiting the doctor or filling a prescription.

 

Houston’s lowest-cost health insurance by mental tier

Depending on the tier you select, Houston health insurance premiums change. The metal tier system allows you to increase your monthly premiums in return for more comprehensive medical coverage or decrease them by accepting higher deductibles and out-of-pocket expenses.

Houston presently offers the following metal tiers: Catastrophic, Bronze, Expanded Bronze, Silver, and Gold. Plans with names derived from more expensive metals have higher monthly premiums but smaller deductibles and out-of-pocket expenses. In Houston, the average monthly premiums for each tier are as follows:

  1. Devastating: $319 monthly
  2. Bronze level: $380 monthly
  3. Expanded bronze ($408 monthly)
  4. Silver costs $495 a month.
  5. Gold costs $587 a month.

Selecting a lower tier choice, such as Bronze or Expanded Bronze, can lower your monthly rates if you’re generally in good health. Paying more each month could prevent hefty deductibles and unexpected costs if you anticipate having regular medical expenses.

The plans with the cheapest monthly premiums for each metal tier are listed in the table below. Deductibles, premiums, and out-of-pocket maximums within a given metal tier may differ significantly in the Houston health insurance market.

Finding out if they qualify for cost-sharing reductions, which apply to Silver plans, can benefit low-income buyers. These can significantly lower your expenses and grant you access to a more comprehensive plan.

 

Houston’s lowest-priced health insurance by metal tier and age

According to data from the Houston health insurance marketplace, age is a major factor in deciding health insurance premiums. In contrast, the average monthly premium for a 60-year-old purchasing a Silver plan is almost $1,051, while the average monthly premium for a 26-year-old purchasing a Silver plan (across all HMO and EPO plans) is $396.

Your monthly health insurance premium increases as you get older. Even while a low-deductible choice, like a Bronze plan, is less expensive per month, you’ll incur more out-of-pocket expenditures if your medical bills are substantial.

Remember that sample ages do not consider how your income can affect premiums as you analyze the available data. For instance, tax premiums and other regulatory support services may cause older Texans to pay less for a health insurance marketplace plan. However, you won’t know your precise quotation unless you apply it to a plan.

 

Cost of Health Insurance in Houston by county

The price of health insurance in Houston can vary based on where you reside. In Houston, there are rating areas, and health insurance companies charge various prices in each location.

Houston has 26 rating areas made up of 254 counties. The average-cost Silver plan in Harris County, the most populated county in Houston, is MyBlue Health Silver 405, which is provided by Blue Cross & Blue Shield of Houston and costs $381 per month.

The typical premiums are for a hypothetical 40-year-old male in Houston who wants to purchase a health insurance policy in that region.

 

Houston’s Lowest Health Insurance Has High Out-of-Pocket Maximums

Younger people with modest medical bills might choose a plan with cheaper premiums and a greater out-of-pocket maximum. If you choose this path, keep in mind that you will pay more out of cash if you experience high medical expenses or an unanticipated medical emergency.

The Friday Catastrophic plan provided by Friday Health Plans in Houston is the least expensive one with the greatest out-of-pocket costs. A 26-year-average old’s monthly cost for this plan is $209.

 

The Lowest Out-of-Pocket Maximums Health Insurance in Houston

Those anticipating high healthcare costs may do better with a high monthly premium and a lower out-of-pocket maximum. Although your monthly premiums will be higher, recurrent medical costs, like visits to the doctor and prescription medications, will help you quickly reach your maximum out-of-pocket maximum. Your insurance provider will begin paying for your medical expenses when you hit this threshold.

Ambetter Secure Care 15 (2021) from Superior HealthPlan is the least expensive plan with a low out-of-pocket maximum in Houston. An average 40-year-old man’s monthly premium for this plan will be $646.

Typically, we define a low out-of-pocket maximum plan as one with a maximum out-of-pocket cost of less than $4,250. The Ambetter Secure Care 15 (2021) plan offers maximum out-of-pocket costs that are somewhat higher at $4,450 annually. Still, it also has the state’s lowest out-of-pocket costs and average premiums.

 

Houston’s Most Affordable EPO/HMO Health Insurance Plan

You can choose the sort of plan to purchase based on your healthcare choices and requirements. The majority of insurance in Houston are HMO (Health Maintenance Organization) plans. The state also provides Exclusive Provider Organization (EPO) plans.

HMO plans frequently provide lower premiums but require you to remain in your provider network to receive treatment coverage. HMO plans and EPO plans are comparable, although EPO plans might not require a referral to consult a specialist.

According to NewHealthInsurance, the least expensive Silver plans for each type of plan are:

  • HMO: Blue Cross and Blue Shield of Houston’s MyBlue Health Silver 405 plan. A 40-year-old, on average, will pay $390 each month.
  • EPO: The Friday Health Plans’ Friday Silver plan. The monthly cost for a 40-year-old is $431.

 

Cheapest HSA-Eligible Plan in Houston

People in good health who do not anticipate making regular doctor visits may choose to purchase a Health Savings Account (HSA). These plans are less expensive and let you pay for medical costs on your own before taxes. This money can serve as savings if you choose not to use it for medical costs.

We discovered that the most affordable health insurance plans in Houston that offer a Health Savings Account (HSA) option are:

  • Friday Health Plans’ Friday Bronze HSA plan, often known as “Expanded Bronze.” An average 40-year-old male must pay $337 annually.
  • Silver: Ambetter from Superior HealthPlan’s Ambetter Balanced Care 25 HSA (2021) plan. For a 40-year-old guy, the cost is $480 a year.

Keep in mind that plans with HSAs typically have high deductibles, so if you incur an unexpected medical expense, your savings may be severely impacted.

 

What Should You Know About Houston Health Insurance?

Keep in mind that the sample rates used in our analysis were derived from information on private plans from the Houston insurance market. When you apply for a plan on the health insurance market, you might be able to locate even more affordable options. Medicaid or Medicare, frequently less expensive than Marketplace insurance, may be available to Houston individuals with lower incomes or older.

 

The Houston Marketplace for Private Health Insurance

The healthcare plans on the Houston Marketplace are divided into multiple tiers. Although catastrophic and bronze plans have the lowest premiums, they have the highest out-of-pocket costs. The monthly premiums for the Gold and Platinum plans are higher, but their total costs are lower.

Each metal-tier health insurance plan complies with all applicable state and federal standards, yet they all have advantages and disadvantages.

  • Catastrophic: Plans with large deductibles and significant out-of-pocket expenses that provide the fewest benefits conceivable are classified as catastrophic. Only those under the age of 30 or those who are financially struggling can purchase these plans.
  • Bronze: Compared to Catastrophic insurance, Bronze plans provide more benefits and lower out-of-pocket expenses. They are great for consumers who only occasionally require medical attention and are seeking a low-cost policy to safeguard them in an emergency. Healthcare is still expensive because of these plans’ hefty out-of-pocket expenses.
  • Expanded Bronze: The Expanded Bronze plan features lower out-of-pocket expenses and slightly more coverage than the Bronze plan. It is more expensive than the Catastrophic or Bronze policies but less expensive than the other options on the market.
  • Silver: The Silver plan is the middle option between Platinum and Catastrophic coverage. Compared to Catastrophic, Bronze, and Extended Bronze policies, they have reduced out-of-pocket expenses, but to make up for the difference, their monthly premiums are greater.
  • Gold: Gold plans can be much more expensive than the lower-tier alternatives, but they have significantly lower deductibles and out-of-pocket expenses than any previously listed plans.
  • Platinum: Of all the plans offered through the Houston insurance exchange, platinum plans feature the lowest out-of-pocket expenses and the highest monthly rates. The Platinum plan can be ideal for people whose medical bills are expected to be exceptionally high in the upcoming year.

Point to ponder!

Keep in mind that depending on your income, you might be eligible for more affordable plans or greater coverage.

You could qualify for premium tax credits if your household income is between 100% – 400% of the federal poverty level. These tax credits are available to two-person households in Houston, making between $17,420 and $69,680 annually. To find out more, use the Healthcare.gov calculator.

You can switch to a different health insurance plan or keep the one you have through the Healthcare Marketplace during the open enrollment period. Normally, open enrollment takes place between November and December; however, because of COVID-19, the government extended these days. Additionally, if you relocate or change your job situation, you might be eligible for a special enrollment period.

 

Medicaid in Houston

Since Medicaid is free, it is the most affordable choice for qualifying residents. Only those who meet Houston requirements can be eligible for this coverage because Houston has not expanded Medicaid. The typical requirements for eligibility include the following:

  • Being pregnant.
  • Having a disability.
  • Having children with low incomes.
  • Having a very low-income household.

 

Medicare in Houston

Houston citizens may be eligible for Medicare, a federal healthcare program, if they are 65 or older or have a qualifying sickness or disability. Some features of Medicare have a cost attached to them, unlike Medicaid. However, Medicare plans are typically less expensive than private insurance policies, especially when compared to them.

Medicare is divided into three sections:

  • Part A: This is basically hospital insurance, which includes coverage for some home health care services as well as hospital stays, care in skilled nursing facilities, and hospice care. It is referred to as premium-free Part A and is free.
  • Your medical insurance, or Part B, pays for some doctor visits, outpatient treatment, essential medical equipment, and preventative services. Your monthly Part B premium is based on your income.
  • Your prescription drug benefit, or Part D, covers medications such as vaccinations and other prescription pharmaceuticals. Prices will change based on your plan.

These Medicare-provided coverages have restrictions, so read the policy carefully before enrolling in benefits.

 

Summary

The most cost-effective option for you will rely on your unique demands and traits; our study is based on estimates. Based on our research, no single plan in Houston is guaranteed to be the most affordable for you.

We researched health insurance plans and costs in Houston across all metal levels and age ranges using data from the Health Insurance Exchange Public Use Files (Exchange PUFs).

The estimated cost of health insurance premiums on this page does not include any potential premium tax credits or cost-sharing subsidies for which customers may qualify.

 

Frequently asked questions

How much does health insurance typically cost in Houston?

A person 40 years of age purchasing a Silver plan in Houston will pay $575 on average for health insurance in 2022. However, the price of health insurance may vary based on factors including your region, age, and the level of coverage you choose. For instance, the cost of health insurance for a 40-year-old is 53% less than for a 60-year-old.

 

Which Houston health insurance provider offers the best value?

Blue Cross and Blue Shield of Houston, which provides the most affordable Silver coverage in 37% of counties, is the most affordable health insurance provider in Houston for the majority of people. FirstCare is another inexpensive business to take into account.

 

Where can I find affordable health insurance in Houston?

When searching for a new health insurance plan in the Houston area, comparing policies from different providers is the best way to ensure you obtain the best value for your money. Identifying which firms place greater emphasis on your location and age can be done by comparing their respective rules. The best insurance plan for you can be chosen after carefully considering your requirements.

 

How does Texas dental insurance operate?

Dental insurance functions similarly to traditional health insurance, with few exceptions. Dental insurance typically covers 50% of major services essential to basic services and 100% of in-network preventive care.

 

In Texas, does Medicaid cover dental care?

Medicaid will provide the most comprehensive dental coverage in Texas, especially for children (anyone under 21). Teeth cleanings are among the covered services. Sealants and fillings.

 

Is UnitedHealthcare vision insurance good for your eyes?

A decent option for vision benefits is UnitedHealthcare Vision. It provides coverage for all of the things you’d anticipate, including visits to the optometrist, frames, lenses, and contacts, and it has a nationwide network of more than 80,000 vision providers.

 

Do you have Blue Cross Blue Shield? Cover your eyes?

All members receive complimentary comprehensive eye exams. Access to more than 117,000 eye care specialists across the country, including Visionworks, LensCrafters, Costco, Walmart, Sam’s Club, Target Optical, Pearle Vision, and others.

Visit our website NewHealthInsurance.com to learn more.

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