A Guide to Health Insurance in Texas (TX)

When pursuing Texas Health Insurance Plans it is essential that you look into all of your options and see which potential policies are available before finally deciding on the best fit.

In many ways finding good health insurance in Texas is far more of a challenge than in other states, with the average cost of a day’s inpatient care in a hospital in Texas costing over $2,000, and yet despite these very high bills that you will be faced with if you don’t have any Texas Health Insurance, there are 25% of the population of Texas (6,234,900 people) who were uninsured in 2011.

The uninsured rate in Texas is the highest in the country, and 50% higher than the already high national average of 16%.

The Costs of Texas Health Care

First let’s get some perspective on the likely healthcare charges that you might be faced with in Texas if you don’t have any health insurance.

The Texas Hospital Association collates statistics of hospital charges throughout Texas, and so it is possible to very accurately gauge how much a stay in a hospital in Texas may cost you.

Here is a list of the 10 Most Common Types of Hospitalizations in Texas in 2010, and the average charge for the treatment according to the Texas Hospital Association:

Normal Newborn - $2,568
Vaginal Delivery without Complications - $9,789
Psychoses - $14,533
Cesarean Section without Complications - $15,742
Neonatal with Other Significant Problems - $6,299
Major Joint Replacement - $59,246
Rehabilitation - $36,244
Digestive Disorders - $20,112
Cesarean Section with Complications - $21,488
Uterus and Adnexa Procedure - $25,541

These amounts cover JUST the hospital portion of the costs, and do NOT include the costs of the actual surgeons to perform any operations or the anesthesiologist. So the final costs which include these will actually be much higher, but even so, the average cost of the 10 most common procedures performed in Texas cost the recipients $21,156 per incident.

And if you are unlucky enough to need something major done like a heart transplant, then you are looking at just the hospital bills costing an average of $440,312 in Texas Hospitals.

If we look at the cold, hard facts of how much health care in Texas costs than the amounts you will need to pay for Texas Health Insurance seem, if not reasonable, then at least somewhat justifiable, and it is important to realize that there are numerous ways of getting Texas Health Care Cover, and that you are not limited to one particular avenue.

The Four Main Types of Major Medical Plans that are available in Texas

There are four main types of major medical plans that can cover you for Comprehensive Texas Health Insurance, and these are as follows:

1/ PPO Plans / Preferred Provider Organization Plans

These are designed around networks of hospitals and health care providers, with the insurance company having entered into contracts with specific hospitals and medical professionals to provide service at a lower rate in return for higher volumes of ‘customers’.

Generally these can be more cost competitive, but they do not offer the same range of treatment options as some other plans.

2/ Indemnity Plans

The advantage of indemnity plans over other types of major-medical plans is that they offer a great deal of freedom over where you seek out treatments, because these type of plans are not usually tied down to one set of hospitals or Doctors.

The way they work is that there will be a deductible, which is the amount you have to pay before the Texas insurance company will have to pay any benefits. And then above that amount costs are usually split, with the insurance company paying 80%, and the claimant 20%.

3/ HMO Plans / Health Maintenance Organization Plans

This is another style of ‘network’ plan, where the insurance company has invested significant energy in forming contracts with networks of hospitals that can provide cover.

With an HMO Plan you will be provided with a Primary Care Physician (PCP) who will take overall management of your care; and if you want to be referred to a hospital or specialist outside the network, then it will generally go through them.

One disadvantage of HMOs over indemnity plans is that treatment that is outside of the network is not usually covered, and so you could potentially end up having to pay a hefty additional bill if you need treatment that cannot be offered within the HMOs network.

4/ POS Plans / Point of Service Plans

These are trying to combine a ‘best of both worlds’ approach, because there is still a primary network of hospitals and care providers that the insurance company in Texas has arranged specific deals with, and you would still have a Primary Care Physician. But with these plans if your PCP refers you outside of the network, perhaps because a specialist is only available elsewhere, then your Texas Health Insurance Plan will pay the cost of the treatment.

Overall, it is important to realize that you do still have many options when it comes to getting comprehensive Texas Health Insurance Plans that properly cover you and that whilst it may seem like a challenge to find the right policy that it is worth persisting until you do so.


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