Your guide to
Individual and Family Health Insurance in Texas
If you are self-employed, between jobs or without coverage through work, you may need a plan of your own. Our agency helps you compare individual and family health plans and understand how they work.
What it covers
What to review in an individual or family plan
Individual and family plans that follow ACA rules are comprehensive coverage. The core benefits are similar, but costs, networks and drug lists vary from plan to plan.
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Essential health benefits
ACA-compliant individual plans cover essential health benefits, such as doctor visits, emergency care, hospital stays and prescription drugs.
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Preventive care
Plans that follow ACA rules include coverage for many preventive services, such as certain screenings and vaccines, when you use in-network providers.
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Spouse and children
Family plans can cover a spouse and children, and young adults can generally stay on a parent's plan until they turn 26.
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Provider network
Plans may use HMO, EPO or PPO networks. Checking that your doctors, hospitals and pharmacies are in network can help you avoid higher costs.
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Deductibles and copays
Your deductible, copays, coinsurance and out-of-pocket maximum shape what you pay when you get care, in addition to the premium.
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Prescription drugs
Each plan has a list of covered drugs. Checking it for the medications your family takes can help you compare plans.
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On or off the Marketplace
ACA-compliant plans may be available through the Marketplace or outside it, but premium tax credits are only available through the Marketplace.
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Why it matters
One plan has to work for the whole household
When a plan covers more than one person, the details matter more. Each family member may see different doctors, take different medications or use care in different ways, so the plan that looks simplest on paper is not always the right fit.
Individual and family coverage generally follows the same enrollment rules as the Marketplace, with an annual Open Enrollment period and Special Enrollment Periods after qualifying life events. Reviewing your plan each year helps you keep up with changes in your household and in the plans available.
Aging off a parent's plan, losing job-based coverage or having or adopting a child may qualify you for a Special Enrollment Period.
Answers
Individual and family health insurance questions
Straight answers to common questions. If yours is not here, call or text our agency.
Many plans let you enroll a spouse and dependent children on the same plan. In some situations, family members may qualify for different types of coverage, so we can help you review the options.
Self-employed people can generally buy individual or family coverage through the Marketplace or outside it. Depending on your household income, you may qualify for a premium tax credit through the Marketplace.
No. Short-term plans are not ACA-compliant major medical coverage, may not cover pre-existing conditions or essential health benefits, and are not a substitute for comprehensive coverage.
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Tell us what you need
Your name, a number that reaches you, an email, and a few quick questions about the coverage you pick. Our team reviews it and calls you back.
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Next step
Let’s review your needs to find the coverage that fits you.
Request a quote online, or call or text our agency. If your current policy already fits, we will tell you that too.