How we choose the best health insurance companies
👋 I’m Alex Rosenberg, a lead writer and content strategist covering health insurance. I built NerdWallet’s health insurance rubric and did the research for this page to find the best health insurance options in the state. I gathered and analyzed data across four major categories:
-
Plans with lower costs, such as premiums, deductibles, copays, coinsurance and out-of-pocket maximums, score the best.
We evaluate plans’ costs using marketplace health plan datasets. These enormous spreadsheets include as many as 149 discrete data points for over 100,000 plan offerings in 31 states that use the federal marketplace (other states use their own separate marketplaces).
It’s not feasible to evaluate every kind of cost in every scenario, so we use these as a sample:
Premiums
Premiums have the highest weight in our scoring. We compare each plan’s unsubsidized premium for a 30-year-old individual as a level playing field for comparison. We score plans based on how cheap they are compared to other plans of the same type and metal — Silver HMOs vs. other Silver HMOs, for example.
Deductibles
The amount you need to pay out of pocket before your plan starts to pay for its share of covered benefits. The lower the deductible, the better.
Out-of-pocket costs
We analyze each plan’s copays, coinsurance and deductibles for primary care visits, specialist appointments, emergency care and several tiers of prescription drugs.
-
Plans score higher if they made covered medical care and prescription drugs more easily accessible.
We evaluate plans’ coverage using the same marketplace health plan datasets that we use to analyze costs along with additional data from government-provided “public use files.”
All marketplace plans have to cover the same essential health benefits, but some plans’ coverage is more usable than others. We score them on how coverage works.
Pre-deductible benefits
We give a strong scoring preference to plans that cover certain benefits before (and also after) you’ve met the deductible. Plans get lower scores when they don’t start to cover things like doctor’s office visits or prescription drugs until you’ve paid the full deductible.
Dental coverage
Plans that cover adult dental care also get more points for coverage than plans that don’t. (Unlike children’s dental care, adult dental care isn’t considered an essential health benefit, so plans may or may not cover it.)
-
Plans score well when they have fewer denials, lower complaint rates and stronger customer satisfaction surveys.
We use three different data sources to evaluate customer experience:
Customer complaints
We collect and analyze customer complaint data from the National Association of Insurance Commissioners. For each company, we calculate a multi-year average complaint rate.
NerdWallet conducts its data analysis and reaches conclusions independently and without the endorsement of the NAIC.
Denials
Based on claims data from the Centers for Medicare & Medicaid Services, we rank companies based on how often they deny in-network claims. The fewer denials, the better.
Satisfaction scores
We rate plans based on how well or poorly they score on government surveys evaluating customer satisfaction.
-
Companies earn points based on their medical management programs and rankings on government ratings of medical quality.
We use two sources to score plans’ quality of care:
Government ratings
Marketplace plans get star ratings from the government based on how well they manage members’ health care, monitor conditions and provide certain medical services. We rank plans based on how highly they score on these ratings.
Medical management programs
Some plans offer medical management programs to help members with certain conditions, such as asthma, diabetes, depression, pregnancy and pain management. Plans score points based on how many of these programs they offer.
Why we picked it: Community Health Choice earns 5 stars out of 5 on our health insurance rubric. It stands out especially for its low complaint rates and relatively low out-of-pocket costs for brand-name drugs. If you’re interested in HMO plans, Community Health Choice’s high government ratings for member experience could make it a strong option to consider.
While Community Health Choice’s Silver plan premiums aren’t the lowest, the company offers the lowest average premiums for Bronze-tier plans, which could be a low-cost option if you’re not eligible for Silver plan subsidies.
Community Health Choice (Texas)Community Health Choice has some of the lowest complaint rates in the state. Competitive out-of-pocket drug costs mean that it could be a good choice, especially if you take brand-name medications. It only offers HMO plans, though, and some competitors’ average premiums are cheaper.
Pros
- Low complaint rates.
- Low out-of-pocket costs.
Cons
- Only HMO plans.
- Premiums aren’t the lowest.
Best for medical out-of-pocket costs: Aetna CVS Health
Why we picked it: Aetna CVS Health, rated 5 stars out of 5 by NerdWallet, has some of the lowest out-of-pocket costs in the state for primary care and specialist office visits, on average. And better yet, those appointments are covered before you’ve paid your full deductible, so those low out-of-pocket costs apply all year long.
If you want to pay as little as possible in copays, coinsurance and/or deductibles for medical appointments, Aetna CVS Health could be a great option.
Aetna CVS Health (Texas)Aetna CVS Health covers primary care and specialist visits without the need to hit your deductible first, and its average out-of-pocket costs for those visits are low. However, its complaint rates are higher than average.
Pros
- Primary care and specialist appointments are covered before you pay your full deductible.
- Low out-of-pocket costs for medical appointments.
Cons
- High complaint rates.
- Only HMO plans.
Most affordable Silver plans: Ambetter Health
Why we picked it: Ambetter from Superior HealthPlan has the lowest average premiums for Silver HMO plans of the companies we reviewed in Texas. If keeping monthly premiums to a minimum is your number one goal, Ambetter might be a good fit.
Silver plans are often the most affordable because they’re potentially eligible for more subsidies than any other plan type. Silver plans can end up costing you less than Bronze plans if you qualify for certain cost savings — and most marketplace enrollees do
[3]
.
Ambetter from Superior HealthPlan (Texas)Ambetter has some of the lowest premiums in Texas and denies fewer claims than average, but its government quality ratings aren’t great.
Pros
- Low premiums for Silver HMOs.
- Low in-network claims denial rate.
Best for low-cost coverage: Oscar Insurance Company
Why we picked it: Oscar Insurance Company, which we rate 5 stars out of 5, has low premiums and low out-of-pocket costs. The company offers affordable prices for both HMO and EPO plans — but not quite as low as Ambetter. And Oscar’s out-of-pocket costs for primary care and specialist appointments are also among the lowest in the state, on average — second to Aetna.
If you’re looking to keep a range of costs low and don’t take many brand-name prescription drugs, Oscar Insurance Company is worth a look.
Oscar Insurance Company (Texas)Oscar offers affordable out-of-pocket costs for doctor’s appointments and low premiums for both HMOs and EPOs, but it gets below-average government ratings for medical care and its out-of-pocket costs for brand-name prescription drugs are pricey.
Pros
- Low premiums, on average.
- Competitive out-of-pocket costs for medical care.
Cons
- Low ratings for medical quality.
- Higher out-of-pocket costs for brand-name prescription drugs.
🤓Nerdy Tip
Bronze plans cover about 60% of the cost of care, which means you’re responsible for about 40% out of pocket. Expanded Bronze plans have the same coverage as regular Bronze plans, broadly speaking, but they either pay for at least one major non-preventive service before you meet the plan’s deductible or function as a high-deductible health plan.
-
See all marketplace insurance companies in Texas.
-
Aetna CVS Health.
-
Ambetter from Superior HealthPlan.
-
Baylor Scott and White Health Plan.
-
Blue Cross and Blue Shield of Texas.
-
CHRISTUS Health Plan.
-
Cigna Healthcare.
-
Community First.
-
Community Health Choice.
-
Imperial Insurance Companies.
-
Moda Health Plan.
-
Molina Healthcare.
-
Oscar Insurance Company.
-
Sendero Health Plans.
-
UnitedHealthcare.
-
WellPoint.
-
How to pick a marketplace health insurance plan
There can be a lot of moving parts when shopping for health insurance coverage. Here are a few questions to help you think through your needs and options:
-
How much are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?
-
Are you eligible for subsidies? Whether applying yourself or with an agent/broker, be sure to enter accurate information to check whether you’re eligible for subsidies through the marketplace.
-
Is your doctor in-network? If you have a preferred doctor (or doctors) or hospital, make sure they participate in the plan’s network.
-
Are your prescriptions covered? If you’re on medication, understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?
-
Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?
If you have questions or need help navigating the marketplace, you can get help from a trained assister or an agent/broker at HealthCare.gov.
Off-marketplace health insurance in Texas
Some marketplace plans have matching policies that can be bought outside of the marketplace. You can choose to buy an off-marketplace plan rather than a marketplace plan during open enrollment (Nov. 1 through Jan. 15), but subsidies aren’t available if you do so.
You might be able to find other kinds of health insurance plans sold outside of the marketplace (and outside of open enrollment), such as limited, short-term or alternative health plans. These plans might not have the same coverage and/or consumer protections as plans sold on the marketplace.
It’s a good idea to check whether an off-marketplace plan offers “minimum essential coverage.” If not, the plan might be allowed to do things that most health plans can’t, such as deny coverage due to health status, limit coverage of pre-existing conditions and/or not cover essential health benefits.
Best Medicare plans in Texas
Medicare is available for people age 65 and older and people living with certain medical conditions. There are many kinds of Medicare coverage, and the best choice for you can depend on your health, finances and preferences. Check out NerdWallet’s reviews of the best Medicare plans:
Health insurance resources in Texas
Marketplace health insurance ratings methodology
NerdWallet evaluates marketplace health insurance plans based on marketplace data about plans’ premiums, out-of-pocket costs and benefits, prescription drug coverage, dental coverage, government quality rating data, complaint data, records about how plans approve and deny claims and more.
We evaluate individual plans and then aggregate scores to the company level. When a plan is missing data for a certain metric, we exclude it from calculations. For example, the federal government calculates official star ratings for marketplace health insurance plans, but many plans are unrated, and others have incomplete ratings. NerdWallet’s analysis incorporates government quality ratings when they’re available, but doesn’t penalize plans that are unrated.
These ratings are a guide, but we encourage you to shop around and compare several insurance quotes to find the best coverage and rate for you. NerdWallet does not receive compensation for any reviews. Read our editorial guidelines for more information.
Insurer complaints methodology
We examined complaints received by state insurance regulators and reported to the National Association of Insurance Commissioners. To assess how insurers compare to one another, the NAIC calculates a complaint index each year for each subsidiary, measuring its share of total complaints relative to its size, or share of total premiums in the industry.
To evaluate a company’s complaint history, we calculated a similar index for each insurance company, weighted by market shares of each subsidiary. We score companies based on this index of how many complaints the company receives relative to its market share.
NerdWallet conducts its data analysis and reaches conclusions independently and without the endorsement of the NAIC.
Read the full article here