Five Tips for Choosing the Right Plan


The ACA marketplace offers insurance coverage to millions; however, the options can be difficult to navigate and can quickly become overwhelming.

Whether you are trying to decide between employer-offered options or are recently uninsured and are exploring the marketplace of medical insurance in Texas for the first time, we’re here to help make the process easier.

Keep reading for our best tips on choosing the healthcare option that is right for you.

Review Your Options

If you are under 65 and employed, your employer may offer some form of health insurance. We recommend speaking with your HR department to determine if you qualify for their insurance. If so, how much will be deducted from your paychecks?

If you’re older than 65, retired, or otherwise unable to work, we recommend looking into your state’s Medicare and Medicaid programs to see if you meet the requirements for coverage.

For those who don’t fall into any of the above categories, such as independent contractors or those looking for a temporary solution while waiting for their insurance to begin, the best option is to look for a plan on the ACA marketplace.

Assess Your Unique Needs

There are certain things to keep in mind while looking for healthcare. First, will the insurance cover only yourself, or do you need it to cover your dependents?

Next, consider your health needs. If you are healthy and rarely go to the doctor, then virtually any plan may work for you.

For those with underlying health conditions or special circumstances, you should look closely at your options. For example, not all marketplace options cover fertility treatments.

Likewise, visits to a specialist, such as a psychologist, may not be covered under all plans. It’s important to check if your current providers and medications will be covered in network or not. This way, you can easily eliminate options that won’t benefit you.

Narrow Down Your Choices

Next, you need to pick between an HMO or a PPO plan.

An HMO, or health maintenance organization, only allows patients to see certain providers who are within their covered network. In addition, you will need referrals to see any specialists. If you visit a provider not covered by the HMO’s network, you will be responsible for 100% of the costs with no coverage.

With a PPO, or preferred provider network, on the other hand, you have a much larger provider pool to pick from, and you can still visit out-of-network providers when necessary. Although you will be responsible for a portion of the cost, the PPO will cover the majority of it.

Additionally, there are different plan tiers for both PPO and HMO insurances. Each of these tiers provides different and increasing levels of coverage as well as differing monthly premiums and out-of-pocket costs.

Research Local Providers and the Plans They Accept

When researching medical insurance in Texas, it is essential to take a look at the hospitals and providers you have access to.

Is there one hospital group that owns the majority of the hospitals in your area? Do many of the healthcare providers work for or with that group? If so, what health plans do they accept?

We recommend finding a plan that your primary care physician and hospital of choice accept to ensure that you’ll be covered when you need it.

Consider Working with a Broker

If you’ve gone through the steps above and are still unsure which healthcare option is best for you, then a broker service like ours can help. Our professional team is well-versed in the intricacies of insurance plans, and we will work with you to review your options.

In many cases, we may also be able to help you secure lower insurance premiums than you would find through the ACA marketplace. And the best part about our services is that they are completely fee-free.

Reach out today to learn how Custom Health Plans can help you find the perfect medical insurance in Texas for your small business and individual needs!



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