Health insurance in Texas is available through group plans, from individual private insurers and through state and federally funded programs. Premium rates will vary according to the type of plan, the insured’s overall health, deductible, levels of service and co-insurance limits. Texans can choose from traditional comprehensive plans, Health Maintenance Organizations (HMOs), and higher-deductible lower-premium programs called HSAs or Health Savings Accounts. Those who qualify are eligible to receive medical coverage through Medicare, Medicaid, SSI, CHIP or the Texas Health Insurance Pool. Eligibility is based on age, family size and family income, as well as access to affordable health care.
An HMO is a system of managed care in which hospitals, doctors and other providers are contracted to provide care. Only those health care expenses from the HMO-contracted providers are covered. According to the Texas Association of Health Plans (TAHP) health insurance in Texas from HMOs accounted for nearly 17% of the population in 2006, down from over 23% in 2001. HMOs became popular as a way to keep health care costs under control by focusing on preventative care such as immunizations and screenings which were not typically covered by traditional plans. HMOs provided them for free or with small co-payments.
HMOs have slowly declined in popularity as a form of health insurance in Texas because access to doctors and care providers is limited to those under contract, and costs for consultations with a specialist are not covered unless the patient is referred by his primary care physician. With the focus on prevention, many other more advanced forms of care are not covered, including treatment and diagnosis. Elective services and those deemed experimental are rarely if ever covered. Many people who prefer the cost advantage of HMO have switched to Health Savings Account plans which offer lower premiums as well as tax advantages.
An HSA plan member can open a separate HSA bank account, into which he can deposit money to be used for all health- and medical-related expenses, except premiums. HSA funds can be used for vitamins, feminine hygiene products and eye drops as well as prescriptions and out-of-pocket hospital costs. Per calendar year, a designated amount of the deposits are not subject to federal income tax, and funds can accumulate from year to year without penalty. As a form of health insurance in Texas, HSAs typically have high deductibles which serve to encourage the policy holder to seek only necessary medical help.