Individual

Individual health insurance in Texas 2019: what you need to know

by Dannie

*Updated 11/6/18. We will keep this blog up to date as the information comes through about open enrollment and plan information!

Good news, Texans! With a small percentage premium increase, the 1.2 million Texans who used the exchange in 2018 will be able to recover from last year's double digit premium increases. 

Texas has 8 insurance carriers offering coverage for 2019. While this is the same number as 2018 there are a few changes. Newcomer Oscar Health is expanding their coverage in Texas for 2019 while Sendero is exiting after Central Health voted to shut down their budget. We’ll break that down more below, but overall this is a positive step for Texans in 2019. 

What’s different this year

  • Availability of short term plans that can last a year. These short term, limited duration plans (STLDs) come with more restrictions, such as limits on preexisting conditions, and offer less coverage (i.e., good bye well-visits and maternity coverage), but their lower price point can be attractive to those that are relatively healthy and looking for more affordability. 
  • Premiums have stabilized. Premiums are predicted to increase only slightly in Texas.  In contrast to the startling jumps in premium pricing the past few years, Modern Healthcare reports that 16 states will see premium declines, two will see no change, and the rest see marginal, single digit increases.  On average, CMS reports that rates are dropping 1.5 percent on average across the country. 
  • Individual mandate disappearing. Beginning in 2019, the Individual Mandate which fines Americans who skip out on health coverage will no longer be in effect. While some think this measure could send premium prices up as the markets adjust for an exodus of healthy young people, it might have less effect than people think. You see, healthy young peeps weren’t buying plans the way families and older folks so and the markets are priced for that. Even with the individual mandate in place, healthy young people could decide to pay $200 a month for health insurance they didn’t think they needed or a $200 fee once a year. 

What’s the same this year

Despite a lot of talk in Washington, the Affordable Care Act (also known as Obamacare) is still intact. 

  • Doctor networks continue to stay small: An ongoing trend since the start of Obamacare, many plans will cover an increasingly smaller percentage of doctors in a given area. That leaves the consumer with fewer choices and a greater chance of having to go out of network to get the care they need. This is a strategy used by carriers to keep costs down, but it leaves consumers financially vulnerable for shouldering those scary and sky-high out-of-network costs. It's always smart to check every year if your doctor will remain on your network. 
  • Shortened enrollment period: Just like last year, open enrollment is only 6 weeks—Nov 1 to Dec 15.
  • Slashed funding: Funding for the marketplace has been further reduced, which means there will be less advertising and awareness campaigns helping people make smart choices. Federal 'navigator' grants to states that are meant to help educate and enroll people in health insurance were slashed by more than half this year.
  • Subsidies: Federal subsidies are expected to be available to those who qualify.
  • Outages: Just like last year, there are 60 hours of scheduled downtime for scheduled maintenance that could get in the way of individuals researching and signing up for plans. Take note that from 12 a.m. to 12 p.m. every Sunday, except for the last Sunday of open enrollment, you can’t access healthcare.gov. 

Who’s in, Who’s out?

Sendero is leaving Texas while Oscar is expanding. Central Health (who owns Sendero) voted to discontinue their Austin based plan’s funding after several years of losses. The September 2018 decision came after rumblings of a potential shut down due to large tax dollar transfers from Central Health to help keep Sendero afloat. Sendero currently covers 24,000 consumers who will unfortunately have to find new coverage for 2019. Four year old Oscar is fairly new to the insurance scene and labels itself as a technology focused health company. They currently offer coverage in San Antonio, Dallas, Austin and will be expanding into El Paso for 2019. 

 

Your options for individual health insurance in Texas 2019

Here's the full lineup for individual health insurance options in Texas this year, including on-exchange plans (aka the plans you can access through the Affordable Care Act's Marketplace, and off-exchange plans that aren't available on the Exchange and are purchased directly from the carrier or a broker. Just remember that you can only access tax credits, if you are eligible, through the ACA marketplace plans. Off-exchange plans are not eligible. 

ambetter logo

Ambetter: On and off

Baylor Scott & White Health provider network will be in network with Ambetter Superior healthplan

  • Ambetter Essential Care (Bronze)-low premiums, higher out of pocket costs.
  • Ambetter Balanced Care (Silver)-best if eligible for government assistance. Balanced premiums an out of pocket costs
  • Ambetter Secure Care (Gold)-higher premiums, lower monthly costs.

Ambetter is expanding coverage into 3 more counties for 2019. Hunt, Starr, and Parker counties will joint the existing 41 counties and 187,000 Texans Ambetter already covers in Texas. 

 

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Blue Cross and Blue Shield of Texas: On and off

  • Blue Advantage HMO (less expensive premium) and Blue Advantage Plus HMO (more expensive premium)
  • Bronze-low premiums, high out of pocket. Plan pays 60%, you pay 40%
  • Silver-high premiums, low out of pocket compared to Bronze plans. Plan pays 70%, you 30%
  • Gold-highest premiums, lower out of pocket than silver plans. Plan pays 80%, you 20%

Blue Cross Blue Shield covers a large number of people in Texas, coming in at just under 390,000 and available in every county. They will continue to offer plans on and off the Exchange for 2019. 

 

christus logo

CHRISTUS Health Plan: On and off

CHRISTUS is expanding their Medicare coverage for 2019. They offer HMO style plans. 

 

Community Health Choice: On

They are offering multiple HMO copay style plans and multiple HMO deductible style plans for 2019. Continuing for 2019, Community Health Choice covers Waller, Jefferson, Montgomery, Harris, Liberty, Fort Bend, Brazoria, Galeveston, Chambers, and Orange counties.  

 

FirstCare Health Plans: On

  • Gold: Low or no deductible  and pay low out of pocket costs 
  • Silver: lower premiums and deductibles can one low as well.
  • Bronze: lower premiums with higher out of pocket costs.

Texas’ own FirstCare Health plans on continuing to serve their 160,000 participants in 89 counties. 

 

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Molina: On

  • Choice Bronze
  • Choice Silver 100
  • Choice Silver 150
  • Choice Silver 200
  • Choice Silver 250
  • Choice Gold 

Molina is a Texas based health insurance company that offers coverage to over 482,000 eligible Texans. They will cover Jefferson, Cameron, Collin, Dallas, El Paso, Harris, Webb, Hidalgo, and Starr counties. 

 

Oscar_Health_logo.svg

Oscar Health: On and off

  • Simple Bronze “just in case” plan
  • Simple Silver: generally healthy 
  • Classic Silver : great for families 

Oscar has expanded into six new markets for 2019; they will cover nine states and 14 markets. 

 

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Scott & White: Off 

HMO and EPO plans

  • HMO Bronze 7500
  • EPO Bronze 7500



vista360

Vista360 Health: Off

Vista has a small coverage area in Texas of only four counties, Bastrop, Hays, Travis, and Williamson. 

Affordable Alternatives You Should Know About

An increasing number of our customers are opting for alternatives to traditional insurance. Here’s a couple of our top picks. They might not be for everyone, but they are worth checking out and comparing to major medical plans on our platform.

Pivot short term plans: Pivot provides short term medical insurance solutions until a qualified major medical health plan is chosen, helping reduce your financial risk. Pivot plans are renewable 90 day plans which in most states can be automatically renewed 4 times without additional medical screening to provide up to 12 months of continuous coverage. 

Faith-based: Faith-based Medi-Share has a state-wide PPO network available in 2019 managed by PHCS (Private Healthcare Systems, now owned by Multiplan). It’s smaller than some of the PPO networks in the past, but it does provide flexibility to see your doctors and will cover out-of-network expenses as long as it meets Medi-Share’s faith-based guidelines. Medi-Share won’t be for everyone, but is a worthy option to consider if it fits your personal convictions and lifestyle. Make sure to check out our Medi-Share review and compare it to other major medical plans on our website before you enroll. 

United Health One: This option offers a lot of flexibility to those looking for a short term solution. First consumers choose the term length- from 30 day minimum up to the state maximum. Then they choose a deductible and coinsurance amount that fits the budget. Enrollees have access to United Health Care’s large network of doctors and hospitals. With United Health One plans you must use a network doctor or hospital in order for insurance to pay for eligible expenses, only emergencies are allowed out of network.

 

Next steps: What's my best option? 

While more choices are a welcome change, hunting down and comparing all of these options can feel overwhelming. However, at TakeCommandHealth.com we help you compare all of your options side-by-side including off-exchange plans, marketplace plans, and faith-based options. You can use our award-winning tools to check your prescriptions, and even simulate conditions and health needs to make sure you get the most of for your money. 

A few other updates we'd like to tell you about: 

We've negotiated some pretty awesome deals for our membersCall a doctor 24/7 for $0, enjoy medical bill negotiation support, a personal health advocate, dental, vision, and pharmacy discounts, etc. These really help save money with some of the higher deductible plans. 

We're pretty confident we have the biggest, most complete line-up of plans in Texas this year. 

With growing demand, we've also put together a bigger support team ready to help you tackle any issue. You can get started by chatting with us on our website or emailing us at support@takecommandhealth.com. 

Once open enrollment begins, you can visit our website and we'll walk you through your options. Our goal is to help you get the most out of your money and find the plan that really works for you and your family. Remember you have until Dec 15th to select a plan that starts Jan 1st, 2019. 

About Take Command Health

Take Command Health launched three years ago with the goal of bringing awareness, advocacy, and transparency to the confusing world of health insurance for small businesses and individuals. Take Command Health is at the forefront of this issue, a recognized leader in QSEHRA administrationand small business tax strategy, with customers in every state. It operates in Arizona, California, Florida, Georgia, Indiana, Michigan, North Carolina, Pennsylvania, Texas, Tennessee, and Wisconsin for individual insurance and offers small business HRA administration nationwide.

Picture of Dannie

Hi, I'm Dannie! I graduated From Salve Regina University in Newport Rhode Island with a degree in Early Childhood Education. I switched careers to the financial industry before being a stay at home mom to my two girls. I love to bake, find new recipes, and travel to visit family. I enjoy educating people through information and Take Command Health is a great avenue to share knowledge on all things healthcare! Learn more about me and connect with me on our about us page. Thanks!