Frequently asked questions

Where does the health plan information on this website come from?

The data for this website comes from health plans regulated by TDI. Each year, health plans report information from the previous calendar year to TDI, as required by Texas Insurance Code Sections 1301.009 and 843.155.

TDI updates this website with the new data each year.

I'm not familiar with insurance terms, is there a glossary?

Yes, visit our glossary of insurance terms.

Why must I give birth dates, tobacco use, county, and relationship information to search for plan information?

We use the information you enter to search health plan information and show you: (1) your estimated premium costs, and (2) which plans you might be able to get. The system does not store your information nor share it with others.

What are “dependents”?

When most people think of dependents, they think of their children. However, dependents can also include parents, siblings, and other relatives if you claim them as a dependent on your tax return.

You can learn more about whom can be claimed as a dependent at IRS.gov and HealthCare.gov.

Is there a limit on the number of dependents I can enter when searching for plans?

No, there isn’t a limit on the number of dependents you can enter.

What are the four types of health insurance plans shown on this website?

  • HMO - health maintenance organization: A health plan that usually limits coverage to care from doctors who work for or contract with the HMO. Out-of-network care is covered only in an emergency, or if you can’t access the care you need in-network. Your care is managed by your primary care provider and you need a referral to see a specialist.
  • PPO - preferred provider organization: A plan that contracts with doctors and hospitals to create a network of preferred providers that can provide care to enrollees at a discounted cost. PPOs will cover some out-of-network costs, but you will pay more and may be balance billed for the difference between the charge and the allowed amount.
  • POS - point-of-service plan: A health plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You need a referral from your primary care doctor to see a specialist.
  • EPO - exclusive provider organization: A health plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).

The type of plan you choose will decide: (1) how much you must pay for doctor and hospital visits, and (2) if you need a referral to see a specialist.

What are the five coverage levels shown on this website?

  • Bronze plan: These plans pay about 60 percent of your medical costs, you pay about 40 percent.
  • Silver plan: Theses plans pay about 70 percent of your medical costs, you pay about 30 percent.
  • Gold plan: These plans pay about 80 percent of your medical costs, you pay about 20 percent.
  • Platinum plan: These plans pay about 90 percent of your medical costs, you pay about 10 percent.
  • Catastrophic plan: These plans have low monthly premiums and very high deductibles. You will pay for most routine medical expenses yourself. These plans may be an affordable way to protect yourself from worst-case scenarios like getting seriously sick or injured. These plans are intended for people under 30 years old, but they are available to people of any age with a hardship or affordability exemption.

The coverage level you choose will decide: (1) how much you must pay, and (2) how much your plan pays. Total costs include premiums, deductibles, and out-of-pocket costs like copays and coinsurance. You will pay the highest premium for a plan where the company pays the highest portion of your health care bills.

Can I get a tax credit with any of these plans?

Maybe. To find out if you can get a tax credit, you must sign up for a health plan on HealthCare.gov. You also will need to file a tax return.

If you get the tax credit (also known as a premium tax credit or an Affordable Care Act subsidy), you can use it to lower your monthly payments (premiums).

You can learn more about tax credits at IRS.gov and HealthCare.gov.

What does a plan's accreditation status mean?

A health plan’s accreditation status is an impartial opinion about its quality. To have an accreditation, a company must have an outside organization review its operations and ensure it meets national standards. A health plan’s accreditation status can help you make a more informed decision when shopping for a health care plan.

Three examples of accrediting organizations:

Where else can I find helpful information?

  • Texas Healthcare Costs gives information on more than 200 of the most common surgeries, tests, and other procedures. You can search by ZIP code to get the average amount billed for a medical service and the average insurance payment.
  • Our Health insurance webpage gives tips and links to helpful information.
  • Our Surprise medical bills webpage gives information about balance billing.
  • Our Your health care coverage webpage gives information about types of health insurance, dependent coverage, pre-existing conditions, health plan costs and benefits, and related information.