Texas Marketplace Health Insurance Plans
Qualified Plans on Health Insurance Marketplace
Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states will offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.
You should also look at a Health Insurance Marketplace plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a Health Insurance Marketplace plan makes sense given your income on the State Overview tab, under the heading, "Do I Qualify For a Tax Break?"
Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.
Depending on where you live in Texas, the number of insurers and plans to choose from varies considerably. For example, residents of Tarrant County, which includes Fort Worth and Arlington, have three insurers to choose from: Blue Cross and Blue Shield of Texas, Cigna and Aetna. Of the 36 health plans available in the county, Blue Cross and Blue Shield of Texas offers half of them, according to Fort Worth Star-Telegram. By comparison, residents of Travis County, located in Austin-Round Rock area in south central Texas, have a choice of 80 plans offered by 7 insurers: Aetna, Humana Health Plan of Texas, Blue Cross Blue Shield of Texas, Cigna, Ambetter from Superior HealthPlan, Scott & White Health Plan and Sendero Health Plans, according to Austin Business Journal.
Provider and hospital networks also vary. For example, Baylor Health Care System, one of the largest hospital systems in northern Texas, is only included in 11 of 36 health plans offered in Dallas County, according to The Dallas Morning News.
Aetna. One of the largest U.S. insurance companies, Aetna has 22 million medical members. Its network includes more than 1 million health care professionals and over 5,300 hospitals nationwide. Aetna offers PPO exchange plans in Catastrophic through Gold tiers.
Ambetter from Superior Health Plan. Superior Health, a subsidiary of Centene Corporation, has provided health services to more than 950,000 Medicaid, CHIP, and Medicare patients in Texas since 1999. Ambetter offers HMO exchange plans in Bronze through Gold tiers.
Blue Cross and Blue Shield of Texas. Blue Cross and Blue Shield of Texas, the state’s largest insurer, is an independent licensee of the Blue Cross and Blue Shield Association, the oldest U.S. health insurance system. The Blue Cross and Blue Shield Association offers coverage in all 50 states, the District of Columbia and Puerto Rico, and has 37 Blue Cross and Blue Shield companies that serve over 100 million members (one-third of all Americans), according to the company. Texans who purchase a Blue Cross and Blue Shield exchange plan may not have access to the entire network of doctors and hospitals. BCBSTX offers HMO and PPO exchange plans in Catastrophic through Gold tiers.
Cigna Health and Life Insurance Company. Formed in 1982, this global health service company is one of the largest U.S. insurers with over 10.2 million members, according to eHealth. In Texas, Cigna’s network includes more than 51,000 doctors and 600 hospitals. Texans who purchase a Cigna exchange plan may not have access to the entire network of doctors and hospitals. Cigna offers PPO exchange plans in Bronze through Gold tiers.
Community Health Choice. This nonprofit, health maintenance organization (HMO) offers coverage in the Texas Gulf Coast region. CHC serves the following counties: Austin, Brazoria, Chambers, Fort Bend, Galveston, Hardin, Harris, Jasper, Jefferson, Liberty, Matagorda, Montgomery, Newton, Orange, Polk, San Jacinto, Tyler, Walker, Waller and Wharton. Its network includes over 9,000 physicians and 70 hospitals. CHC offers HMO exchange plans in Bronze through Gold tiers.
CommunityFirst. Established in 1995 by the University Health System, this locally owned, nonprofit company provides health coverage to residents of Bexar and the surrounding seven counties in southern Texas. CFHP offers HMO exchange plans in Bronze through Gold tiers.
Firstcare Health Plans. Established in 1985, this for-profit Texas-based company is owned by two religiously affiliated nonprofit health care organizations: Covenant Health in Lubbock and Hendrick Health System in Abilene. Firstcare offers HMO exchange plans in Bronze through Gold tiers.
Humana Insurance Company. Established in 1974 in Louisville, Ky., Humana is one of the largest U.S. health insurance companies with over 11.5 million members. Humana offers EPO exchange plans in every tier.
Humana Health Plan of Texas. A subsidiary of Humana, Humana Health Plan offers HMO exchange plans in every tier.
Molina Healthcare of Texas. Established in 1980 in California, Molina is a multi-state health care organization with a focus on providing government-sponsored health services to over 5 million Americans in 15 states, according to the company. Molina offers HMO exchange plans in Silver and Gold tiers.
Sendero Health Plan. Established in 2011 in central Texas, this new nonprofit was established to help improve health care services for those enrolled in publicly-funded health insurance programs. Sendero Health offers HMO exchange plans in Catastrophic through Gold tiers.
Scott & White Health Plan. Established as a nonprofit health maintenance organization, Scott & White Health plan has been serving five counties (College Station, Hill Country, Round Rock, Waco and Temple) in central Texas since 1982. In late Sept. 2013, Baylor Health Care System and Scott & White Healthcare merged to form the largest nonprofit health system in Texas, reports the Dallas Business Journal. The system offers 43 hospitals, over 6,000 physicians, and includes more than 500 patient care sites. A list of in-network primary and specialty care clinics and hospitals is available. Scott & White Health offers HMO exchange plans in Bronze through Gold tiers.
Last updated by Heilbrunn, Evi | December 5, 2013