How to Choose Health Care Coverage

How to Choose Health Care Coverage

This article is intended for members enrolled in an individual health insurance plan.Lee esto en Español

As you prepare to buy coverage, there is some important information you can gather to help decide what plan is best for you and your family.

Who Do You See?

Use our Provider Finder® online tool to make sure any providers you see are in the network for the plans you are considering. Providers may change networks periodically. To access Provider Finder, log in to Blue Access for MembersSM and click on the Find a Doctor or Hospital tab.

What Affects How Much You Spend?

Your costs for health care coverage include:

  • Monthly premium: Generally, the higher the monthly premium, the more the plan pays for covered services. This is important to remember if you have a chronic condition or, for example, you are planning to have a child.
  • Deductible: Deductibles are the amount members must pay out of pocket before their benefits start paying claims. Plans with higher deductibles may have a lower monthly premium. Remember, you must meet the plan’s deductible before the plan starts paying benefits.
  • Cost sharing: Additional out-of-pocket payments, such as copays and coinsurance.
What’s Coming Up? Or Might?

We can’t predict the future. Illnesses, injuries and joyous events happen, often unexpectedly. But sometimes there are clues ahead of time.

Family history may suggest some chronic conditions are likely to develop around certain stages of life. In that case, consider plans with lower copays to offset frequent visits.

Certain sports activities may raise the risk of getting hurt. You may want to look at plans with a lower deductible in case larger copays or an extended stretch of office visits come up.

Anyone who faces stress or grief may find it helpful to see a therapist. Those visits may require copays as well.

Is a Health Savings Account (HSA) Right for You?*

An HSA is a special savings account that you may use to cover a wide range of qualified medical expenses. An HSA can help you take charge of your health and be responsible for how you spend your health care dollars.

For many people, using an HSA is an effective way to help manage the costs of health care. Not all plans are HSA compatible, so review your options carefully.

Please note that certain individuals who receive cost-sharing reductions under their benefit plan that reduce the deductible below the federal government’s minimum deductible may not be eligible to contribute to a Health Savings Account. Please consult your tax adviser for more information.

One of our licensed sales agents or your independent, authorized Blue Cross and Blue Shield of Texas agent can help you understand your options.

What Medicines do You Take

Prescription medication coverage and copays or coinsurance amounts can vary between plans.

 Generic drugsAll health coverage plans we provide have a drug list, or a list of drugs the plan will cover. Within that list, there are payment level tiers. Drugs that are in a lower tier will usually cost you less.

If any of your medications appear to have moved to a higher tier with a higher out-of-pocket cost, you may want to consult with your doctor to ask if there are lower tier alternatives or generics available.

Generics typically work like a brand drug at the same dose, strength and use. Generics are also approved by the Food and Drug Administration.

For some drugs, your doctor may need to document certain symptoms or test results before your prescription drug coverage may be approved.

*Health Savings Accounts (HSAs) have tax and legal ramifications. Blue Cross and Blue Shield of Texas does not provide legal or tax advice, and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended to be used, and cannot be used or relied on, for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You should seek advice based on your particular circumstances from an independent tax adviser regarding tax consequences of specific health insurance plans or products.
Source: Generic Drug Facts, leaving site icon U.S. Food and Drug Administration, 2017

Originally published November 21, 2019; Revised 2020, 2021

  • Good evening, as an ex-employee of ECISD, I was covered by BCBS, and never had to pay regular fees at the doctor's office; all we ever had to pay was the copay; I went to the doctor for a follow up last week, and had to pay about $132.00's or so, and was told that my husband and I have to meet our deductible first!  We've never done that and usually paid the deductibles through the lab/X-Ray fees.  I retired on May 31, 2021, and just started the new coverage through TRS-Care on September 01, 2021, so does this mean that our year will always start on September 01, 2021, and end on September 30, 2022 - with the deductible starting again at that time?  One last question is, what is our copay for both health and pharmacy using in-network and out-of-network?  Thank you, any questions you can answer will be a big help. 

  • my member, I wasnt able to pay the premium and my policy cancelled.  can you tell me how I can apply for coverage again