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Home » Health Insurance in Plano, TX

Health Insurance in Plano, TX

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Health insurance can help reduce your out-of-pocket health care expenses. You have numerous choices when it comes to health insurance coverage, so it’s crucial to work closely with an experienced agent when choosing your policy.

Contact LSI Insurance Services, LLC today to find health insurance coverage that works for your situation.

How Does Health Insurance Work?

Health insurance is designed to help individuals and families pay for certain medical expenses and services.

When you enroll in health insurance, you choose a specific type of plan. Each plan has different rules, benefits and networks of health care providers. To have health insurance coverage, you typically pay a regular premium, which is a set amount you contribute either monthly or annually.

Health insurance typically includes out-of-pocket costs, including the following:

  • Deductible is the amount you must pay out of pocket for certain covered medical services before your insurance starts to cover the costs.
  • Copayment is a fixed amount you pay for specific services, such as a set fee for a doctor’s visit.
  • Coinsurance is a percentage of the total cost of a medical procedure or service that you’re responsible for paying.

Health insurance plans often have a network of health care providers which typically includes doctors, hospitals, clinics and specialists. Depending on the plan you choose, you may need to use providers in the network to receive the maximum coverage. Going out-of-network may result in higher costs or limited coverage, although emergency care may be covered regardless of the provider.

Health insurance plans typically cover a range of medical services, including preventive care, hospitalization, prescription drugs, laboratory tests and certain treatments. The specific coverage details, limitations and exclusions vary depending on your plan and insurance provider. It’s important to review the plan’s Summary of Benefits and Coverage to understand what is covered.

When you receive medical care covered by your insurance, the health care provider typically submits a claim to the insurance company on your behalf. The insurance company processes the claim and pays the portion of the covered expenses according to your plan’s terms.

Health insurance plans can have different rules, cost-sharing structures and coverage options. Review the terms and conditions of your specific health insurance plan to understand how it works and what services are covered.

Types of Health Insurance

There are several different types of health insurance plans, each with its own characteristics and features. Some of the following may be available to you:

  • Health maintenance organization (HMO) plans typically require you to select a primary care physician (PCP) who acts as the main point of contact for your health care needs. With an HMO, you may need a referral from your PCP to see a specialist.
  • Preferred provider organization (PPO) plans may offer more flexibility in choosing health care providers. However, staying within the PPO network usually results in lower out-of-pocket costs, while using out-of-network providers may involve higher deductibles and co-payments.
  • Exclusive provider organization (EPO) plans are similar to PPO plans but they do not provide coverage for out-of-network care, except in emergency situations. Like PPOs, EPOs typically do not require referrals for specialist visits within the network.
  • Point-of-service (POS) plans combine elements of HMO and PPO plans. You choose a primary care physician within the network and can see specialists inside and outside the network. Seeing out-of-network providers generally requires a referral from your primary care physician, and the coverage for out-of-network care may be limited.
  • High deductible health plans (HDHP) typically have higher deductibles and lower premiums. They are often paired with a health savings account (HSA), which allows you to set aside pre-tax funds to pay for eligible medical expenses. HDHPs are designed to cover catastrophic costs while promoting consumer engagement in managing health care expenses.
  • Catastrophic health insurance generally offers low monthly premiums but high deductibles. Catastrophic plans typically provide coverage for essential health benefits after the deductible is met.

It’s important to carefully evaluate the features, network coverage, premiums, deductibles and out-of-pocket costs associated with each type of health insurance plan to select the one that aligns with your health care needs and budget.

Contact Us

Contact LSI Insurance Services, LLC in Plano, Texas, to learn more about your health insurance options and get a personalized health insurance quote.

Attention Texas residents: As a result of the 2023 Consolidated Appropriations Act, which ended the continuous Medicaid coverage requirement under the Families First Coronavirus Response Act, as of April 1, 2023, states may begin unrolling members who are no longer eligible.  If you or anyone you know has been affected by the “unwinding Medicaid program,” please reach out to one of our qualified agents for coverages options.

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