Common Insurance Questions and Answers

​​Health insurance protects you and your family from financial losses the same way home and car insurance work. Incluso si tiene buena salud, nunca se sabe cuándo puede tener un accidente o enfermarse. One key benefit of health insurance is access to a network of doctors, hospitals and other resources to help you stay healthy. ​​

If you purchase a health plan for yourself and your family, you have an Individual and Family plan. This means you don't have coverage from an employer, Medicare or Medicaid. 

Individual and Family plans are plans you enroll in on your own during the Open Enrollment Period or during a Special Enrollment Period if you have a qualifying event. Estas coberturas incluyen una amplia gama de servicios y:  

• Duran un año o más. 
• Por lo general, se pueden renovar 
• Meet the essential requirements set by the Affordable Care Act (ACA), including: 
  • Servicios de emergencia, hospitalización y cuidados preventivos
  • Maternidad, atención neonatal y pediátrica 
  • Atención médica para la salud mental y tratamientos para el abuso de sustancias controladas 
  • Servicios de laboratorio, medicamentos recetados y manejo de enfermedades 
  • Servicios y dispositivos de rehabilitación 

If you enroll in an Individual and Family plan, you may be able to get help paying for it with a premium tax credit, known as a subsidy. Más información sobre cómo recibir ayuda financiera para reducir su factura mensual.

Medicare is coverage for people 65 and older - along with people under 65 with certain disabilities and illnesses. You can enroll in individual Medicare or get Medicare as a retiree through your employer. 

Original Medicare includes Part A (hospital) and Part B (medical). You can beef it up with additional coverage, including: 

• Part C – Medicare Advantage Plans offer all-in-one coverage, some with built-in prescription drug coverage.
• Part D – Prescription drug coverage pays for approved drugs not covered by Original Medicare Part A and B .
• Medicare Supplement Insurance Plans – Help pay for health care costs not covered by Original Medicare .

¿Necesita más información? Asista a un evento con nosotros.

Medicaid is a joint federal- and state-funded program that provides health care coverage for low-income children and families, along with certain aged and disabled individuals. 

Medicaid y CHIP son tipos de seguro de gastos médicos que ofrece el gobierno a bajo costo o gratis. Su elegibilidad se basa en el tamaño de su hogar y los ingresos, y usted puede presentar su solicitud en cualquier momento del año. Si es elegible, la cobertura puede comenzar de inmediato. 

• Para el Programa Medicaid,  visite Medicaid.gov.
• Para la cobertura CHIP,  visite insurekidsnow.gov  o llame al  1-877-543-7669.  

Worried you may be having a heart attack? Did you black out after a nasty fall? Are you coughing up blood? Go to the hospital emergency room (ER) or call 911 when you have a medical emergency. ER doctors and staff are trained to treat serious and life-threatening health issues. Plus, the ER is open 24/7. Use nuestro directorio en línea Provider Finder^® to make sure a specific ER is in your plan’s provider network.

If you get your coverage through your employer, an association or other organization, you are in a group plan. 

Many plans cover health, dental, vision and more. Still, some may only cover health. You may need a separate policy for dental and vision coverage. 

Dental and vision insurance plans help cover dental and vision costs for you and your family. These types of plans can: 

• Cover a wide range of dental and vision services, including routine care like annual visits. 
• Be bought as part of your Individual and Family health plan or as stand-alone plans.  

Most health plans include prescription drug benefits. Medicare has a stand-alone prescription drug plan. Your coverage will depend on your plan. Some prescriptions, like specialty drugs used for chemotherapy, may be covered under your medical benefit.

BCBSTX has network pharmacies, just like network doctors and hospitals. We secure discounts on drug costs by contracting with these pharmacies. Our network includes retail and local pharmacies in your area, plus national chains and mail order pharmacies.

Learn more about prescription drug coverage.

An HMO is a type of health plan that provides health care coverage to its members at a lower cost because you have one doctor, a primary care provider (PCP), coordinating your care. You'll have lower copays and other out-of-pocket costs when you work with your PCP to schedule appointments with other health care providers.

Más información sobre las coberturas HMO.

If you like having the flexibility to choose the doctors, hospitals and other health care providers you use for care and you can afford to pay more, PPO insurance may be the right plan for you and your family.

PPO plans let you choose where you go for care. You don't need a referral from a PCP. You aren't limited to certain providers in your plan's network. PPO's often have higher monthly premiums and out-of-pocket costs like copays, coinsurance and deductibles. With BCBSTX, there are different PPO plans to help meet your budget and health needs.

Más información sobre las coberturas PPO.

A CDHP is a health plan with a health savings account (HSA) or other tax-advantaged account like a flexible spending account (FSA). These plans give members more control of health care expenses. 

Más información sobre HSAs y FSAs.

An HSA is an account that you can use to pay for qualified medical expenses, including dental and vision services. 

Things to know about an HSA:

• Pre-tax contributions: If you are eligible for an HSA, you and your employer can make tax-free contributions (up to the annual limit) to your HSA.
• Tax-free withdrawals: As long as you are paying for a qualified medical expense, withdrawals from your HSA are tax-free. 
• Portability: Take your HSA account with you, even if you change jobs or health plans.

Más información sobre las HSA.

An FSA is a CDHP where you use pre-tax dollars in your account to pay for qualified expenses. There are different types of FSAs but most common is one used for medical expenses. Sometimes it's called a Health Care Flexible Spending Account (HCFSA).

You can choose to have an FSA if your employer offers it. You set aside a part of your earnings for the account. An FSA can be used along with any traditional health insurance plan.

Your employer owns your FSA. You can't take your FSA account with you if you change jobs or retire.

Learn more about FSAs.