Qualifying health coverage -- that is, plans that meet the requirements of the Affordable Care Act (ACA) -- are not only available on health exchanges. Some insurance companies sell private health plans that are available outside of the open enrollment window that still meets all of the requirements of the ACA. Understanding how these plans work is the key to finding the best off exchange health plans in Texas.
First, understand that these plans are not listed on the Marketplace. Instead, you can find these plans through agents, brokers, insurance companies, and some third-party online health insurance sellers. It’s also important to note that these plans do not allow you to receive premium tax credits or other subsidies that may be income-based.
Where to look
If you will not qualify for health insurance subsidies based on your income, you may want to consider seeking one of the best off exchange health plans in Texas. You can find these types of plans in one of three ways:
From a health insurer. Most insurance companies have a phone number and a website where they can be contacted. The website should list any plans available in your area and many sites will enable you to compare different plans from the company. They may also include both plans that are offered on healthcare.gov as well as off exchange plans.
From a health insurance agent or broker. Working with an agent or a broker can be a streamlined way to find one of the best off exchange health plans in Texas. Agents and brokers are slightly different in how they work; agents usually work for one health insurance company while brokers may offer plans from a variety of insurers. Both can help you compare plans based on your unique specifications, so you can see features and prices side-by-side. It doesn’t cost you any money to work with an agent or broker as they are compensated by the insurance companies.
From a third-party health insurance seller. These are websites and online services that offer health plans from a variety of health insurance companies. Similarly to working with a broker, these sites enable you to compare prices and features and also enroll with the insurance company on the spot.
What about non-ACA plans?
When sorting through the best off exchange health plans in Texas, be aware that there are both ACA and non-ACA plans available. The latter is anything that is not compliant with the stipulations of the ACA. It is important to do one’s due diligence when sorting through non-ACA plans. These usually do not afford members the same benefits as ACA plans, including coverage for pre-existing conditions or preventive care measures. Some may even fall a little outside of the realm of “insurance”, like faith-based cost-sharing plans.
Short Term Medical Insurance (STM) falls into this category, too. These plans originated as a way for people to bridge the gap between longer plans (for maybe a few months); however, a 2019 federal rule lifted the 3-month limit and extended the duration to 365. It also made these plans renewable for up to three years in certain states. These off exchange plans are not eligible for federal subsidies or financial aid, though some premiums may be less expensive than those sold on the exchange. These plans are also not required to cover the full range of health benefits required by ACA.
Other options
As mentioned earlier, there are some additional options available to people looking for the best off exchange health plans in Texas. While these may not be official “insurance” plans, they provide some flexibility to those who may have unique needs or who want to purchase a plan outside of the Marketplace.
Health Sharing Ministries
A healthcare sharing ministry is an organization that facilitates faith-based cost-sharing plans. A group of people with common religious, faith, or ethical beliefs can pool together to pay a “sharing amount” each month. In some cases, these plans operate very similarly to traditional health insurance plans in that they have out-of-pocket limits, provide discounts on care, and have predictable sharing amounts each month. Some are even cheaper than traditional health insurance plans.
That said, they come with certain restrictions and without many of the protections offered by ACA plans. Many impose annual or lifetime limits on coverage, meaning any costs that exceed these caps are left to be covered by the individuals or families themselves. Since they are centered around a group’s religious or ethical beliefs, many require members to sign a statement of faith or make a similar declaration. Another result is that some coverage is deemed unnecessary and may not be covered, including many birth control options. Since these plans are not technically insurance plans, they are not regulated by the Department of Insurance, they do not provide many of the protections of traditional health insurance plans. Those looking for the best off exchange health plans in Texas should be aware of all the differences when considering health sharing ministries.
Prescription Discount Programs
Prescription discount programs may be another alternative for those seeking the best off exchange health plans in Texas. These are not insurance plans, but a way for people to potentially save money on prescriptions. There are several different prescription discount programs, including GoodRx, ScriptSave WellRx, and discount-drug programs offered through chain stores and pharmacies.
On or off-exchange, Decent comes through
Whether you’re adamant about choosing a plan through the Marketplace or looking for one of the best off exchange health plans in Texas, Decent is here to help. You can enroll in our ACA-compliant plans during the Open Enrollment window through your local or federal exchange. If you find yourself needing an insurance plan outside of the Open Enrollment window, we have great news: our plans are available 365/24/7. That means you can enroll in one of our affordable, comprehensive plans any day, any time.
Each of our plans has been elegantly tailored to meet the needs of self-employed individuals:
Pathfinder Bronze Plan — Perfect for those who want to be covered in case something bad happens. Members of this plan enjoy the lowest premiums in Austin.*
__Lonestar Bronze Plan __— Excellent for people who expect to use their insurance from time to time. Members of this plan geek out on the $0 medical deductible.
Trailblazer Silver Plan — Best fit for people with families, medical conditions, or prescriptions. Members of this plan brag about the manageable copays for most everything.
We make it super simple to take advantage of the best off exchange health plans in Texas. Our plans are affordable and available year-round to help meet your needs. We also believe strongly in the doctor-patient relationship, which is why we created all of our plans around Direct Primary Care (DPC). How? By offering free primary care. You pay nothing ($0) to see your doctor, whenever and as often as you’d like. You can choose standard or virtual options depending on whether you’d prefer to see your doctor in-person or through virtual visits. No copays, just you and your doctor working together towards your best health. Sound like a plan you want to be a part of? __Get your free quote today. __https://www.decent.com/
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