Health Plans
This section of Texas Health Compare is designed to help with your health plan-related questions - especially about quality and costs. If you have questions about specific health care coverage issues, send them to ConsumerProtection@tdi.state.tx.us.
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Quick Links: Cost & Quality | Additional Advice
Developed by:
Texas Health Care Policy Council & the Texas Department of Insurance
Compare Cost & Quality . . .
The state's HMO "report card" - Comparing Texas HMOs - is one tool available to Texans wanting to compare health plans by region or across the state. It also offers consumer satisfaction, complaint, market share and financial data, as well as contact information for each health plan.
The Office of Public Insurance Counsel, which produces the "report card," and the Department of State Health Service's Center for Health Statistics also have a Guide to Texas HMO Quality that provides a detailed analysis of each HMO's strengths and weaknesses.
For those needing information on Texas Medicaid programs, please refer to the Texas Health and Human Services Commission's publication Texas Medicaid in Perspective.
The Texas Department of Insurance provides a number of helpful publications and rate comparisions for various types of health plans. Among them are:
- The Small Employer Benefit Plan Rate Guide [ www.tdi.state.tx.us/consumer/serg01.html ] - a region-specific guide to small employer health plans. The publication is designed to help businessowners with 2-50 employees save time while shopping for a health plan.
- The online version of the Medicare Supplement Rate Guide [ www.tdi.state.tx.us/consumer/medsup.html ] includes companies that sell one or more of the Medicare plans (Plan A through Plan J), with rates for ages 65, 70, and 75, as well as those under age 65 with disabilities. Group policies are listed at the end of each individual plan list. A PDF version of the guide is at [ www.tdi.state.tx.us/consumer/documents/cb014.pdf ].
- Medicare Advantage Plans [ www.tdi.state.tx.us/consumer/cb036.html ] are an option for seniors eligible for Medicare or already on Medicare. You may be able to join a Medicare Advantage plan depending on the city or county where you live. Medicare Advantage plans are offered by private companies that enter into contracts with the Center for Medicare and Medicaid Services (CMS), the federal agency that administers the Medicare program. The plans have at least the same benefits as Medicare Part A and Part B coverage. Some may offer additional benefits. This publication provides general information about Medicare Advantage options in Texas. More information is available at the Medicare website [ www.medicare.gov ] under "Plan Choices."
- The online version of the Long-Term Care Insurance Rate Guide
[ wwwapps.tdi.state.tx.us/inter/asproot/consumer/ltcrgsearch/
ltcrgintro.html ] includes insurer sample rates. A PDF version[ www.tdi.state.tx.us/consumer/hicap/documents/ltcrgintro.pdf ] is available with information on shopping for long-term care coverage.
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Some additional advice . . .
Find the Best Health Plan for You
Experts suggest you look for a health plan that best fits your needs in terms of cost, benefits, and access to particular doctors. Whether you select a more traditional type of health plan or a managed care type plan, what's most important is to understand your plan's options and how they affect your choice of providers.
Ask a lot of questions when selecting a health plan:
- Is the health plan accredited?
- Is the plan rated high on things important to you?
- Are preventive services offered to help keep you well?
- Can you use the doctors and hospitals you want or need?
- Does the plan provide the benefits you need?
- Do the doctors, pharmacies and other services in the plan have convenient times and locations?
- Does it fit your budget?
Additional resources
You can find more useful information and advice at TexasHealthOptions.com. The website [ www.texashealthoptions.com ] provides help to Texans looking for health coverage, including individuals, children, students, seniors, disabled Texans, the unemployed and owners of small and large businesses. TexasHealthOptions is one of several websites operated by the Texas Department of Insurance.
YourTexasBenefits, a website [ www.yourtexasbenefits.com/wps/portal ] of the Texas Health & Human Services Commission, offers online applications to Medicaid, Food Stamps, Temporary Assistance for Needy Families (TANF), Children's Health Insurance and nursing home care and other services for people who are elderly or have disabilities.
The Texas Health Care Information Collection (THCIC) website [ Texas Hospital Inpatient Care Quality Measures ] gathers information from health maintenance organizations and hospitals and publishes reports to help consumers compare and choose their health plans and hospitals.
Medicare's Long-Term Care Planning tool [ www.medicare.gov/LTCPlanning ] helps you understand (1) what long-term care services are available; (2) how much you can expect to pay for long-term care; and (3) what financing options are available to support your long-term care costs. It provides general recommendations not intended to replace comprehensive financial and other long-term personal planning and includes 12 to 20 questions that help compare your results against individuals with similar profiles.
Medicare's Paying for Long-Term Care tool [ www.medicare.gov/LongTermCare/Static/PayingOverview.asp ] takes a detailed look at various ways of financing long-term care, from government programs to reverse mortgages.
The Government Benefits Portal [ www.govbenefits.gov> ] helps determine whether you qualify for various federal government benefits, including help with your long-term care needs.
The National Council on Aging (NCOA) website [ www.ncoa.org ] helps persons age 55 and older and those on Medicare connect to hundreds of programs for seniors, including prescription assistance help. NCOA's BenefitsCheckUpRx website [ www.benefitscheckup.org ] includes a short and simple questionnaire to determine whether you may qualify for assistance. The website serves as a confidential screening device. It does not (1) determine actual eligibility, (2) calculate benefit amounts or (3) enroll you in any programs. However, it does help determine if you are likely to be eligible, and provides advice and information on how to apply for benefits.
Another way to research Texas HMOs is the NCQA's Health Plan Report Card, which compares accredited plans by zip code or by state and types of health plans. NCQA's latest reports on the best health plans in the country are available at www.ncqa.org/tabid/60/Default.aspx. The site compares only health plans that the organization has accredited (see the site's explanation of health-plan participation). It also describes how to use the NCQA results.
The Texas Department of Insurance Workers' Compensation Rate Guide [ www.tdi.state.tx.us/wc/regulation/rcomp.html ] helps businesses comparison shop for workers' compensation and employers' liability insurance.
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The list of websites included here should not be considered complete, nor should their inclusion be considered as an endorsement by the Texas Department of Insurance. TDI does not assume any responsibility for the accuracy of the websites listed.
For more information contact: