What to do if You Can't Get Texas Health Insurance through Work

7. If you are looking for health insurance but can't get it through your job...

...you may have to look for an individual health insurance policy in the private market.

Here are some tips to help you:

• Shop carefully before buying insurance on your own because coverage and costs vary from company to company. When shopping for insurance, keep the following terms in mind and ask questions like:
  • Covered Services: What medical services are covered?
  • Deductible: How much must I pay before the insurance starts to help pay for services?
  • Co-payments: After I reach my deductible, how much do I pay for services, and how much does the insurance company pay?
  • Out-of-Pocket Maximum: Does the policy limit the total you have to spend for covered services in a year? Check the maximum carefully; sometimes not all spending counts toward it (for example, the deductible or co-payments for care from doctors outside the plan's network).
  • Pre-existing Conditions: Does the plan cover health problems I already have? If it does not cover these problems right away, when would it begin covering them? (Also see "Your Rights under Federal Law" on page 7.)
  • Provider Network: Are the doctors I want to see covered in this policy? If not, would I have to pay extra to see any of my doctors because they are not "in the network"? You may want to ask your doctor directly if they would accept this insurance for your care.
• Talk with a health insurance agent in your area to help you think about the right policy for the right price. (Agents are listed in the yellow pages.) As you weigh your options, remember that you buy health insurance in case you get sick, not in case you stay healthy. Bare-bones policies that may seem adequate when you are healthy might leave you with high unpaid medical bills if you get seriously sick or injured.
• Be careful about plans that don't offer insurance coverage but offer only discounts on the cost of health care services. Generally, these plans are not a good buy, and many insurance regulators warn against buying them.
• Be sure to find out if the insurance company you are thinking about buying coverage from has been licensed in Texas and if there have been complaints about the company. This is especially important to do if you are thinking about buying health insurance through an association. For this information, contact the Texas Department of Insurance at 1.800.252.3439.
• Know your rights. Because you may run into problems shopping for an individual policy, you should be aware of your rights and protections under federal and state law. One resource for learning more about these federal and state protections can be found at www.healthinsuranceinfo.net. This Web site has a separate guide for each state.