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It's possible that I may move to Texas next year. Ignoring any potential legislation changes, I'd like to understand what my options are going to be, health-care-wise. I will likely earn a respectable salary, so I don't expect to need to be very stingy and look for the cheaper options - but I have heard health care is incredibly expensive in the US and that the health insurance companies may rip people off or exploit their poor choices of plans etc.

Specifically:

  • What are the different classes or categories of health coverage or health plans? I know that there are plans which are offered following the Affordable Care Act, but that those are kind of sub-par, and that there's such a thing as "cadillac plans".
  • According to this page, there are only 3 health care providers to individuals: Blue Cross/Shield, FirstCare, Oscar Insurance. Are these indeed the only places I should be looking for health coverage options?
  • My employer will likely offer me some kind of plan - they're just starting to set these things up so there are no details yet. Is it typically a good idea or a bad idea to opt for the plans employers offer? (I don't mean terribly exploitative employers, but rather - small tech companies.) Or - do employers, even small ones, typically get better conditions than what you can get as an individual?
  • Are there some kind of health-care "consumer" collectives or cooperatives for bargaining with care providers? Perhaps something the labor unions have?

Note I didn't ask for recommendations for any specific plans since I assume that would be somewhat opinion-based and possibly biased.

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A majority of non-retired Americans, the vast majority if you exclude people poor enough to qualify for Medicaid, have employer-based health insurance. Employer group insurance premiums tend to be lower for what you get (self-selection effects in the individual market tend to make those risk pools sicker), and are cheaper still because the premiums are paid in pre-tax dollars. Virtually everyone who can get health insurance from their employer takes it.

Note that there is nothing "sub-par" about ACA insurance, in fact one of the big advantages of the ACA is that it puts quite a high floor under what coverage qualifies as "health insurance" so you can count on the plan you get to provide meaningful coverage. The major differences between plans are their actuarial value (i.e. what fraction of costs you are expected to pay out-of-pocket) and which providers accept the insurance plan you have. If your employer offers several plan options the people who can provide the best help telling them apart are people who live where you will since they'll have opinions about which providers are best to have available.

In any case the short answer is to take your employer's insurance. The individual market exists only for people who don't have that option and is bound to be more expensive for the same coverage.

  • And can you tell me where I could find information regarding the plans employers have access to? – einpoklum - reinstate Monica Sep 22 '17 at 17:34
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It's typically a good idea to take the employer's health plan. The maximum out-of-pocket costs under such a plan (that is, assuming the worst case where you get terribly sick) are typically similar to what you'd pay just in premiums to buy a plan for yourself (that is, assuming the best case scenario where you don't use any healthcare services at all).

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Here's a comparison between what are apparently the main categories of health plans:

| Type |Requires PCP | Requires referrals | Requires pre-authorization          | Pays for out-of-network care | Cost-sharing                             | Requires claim paperwork?  |
|------|-------------|--------------------|-------------------------------------|------------------------------|------------------------------------------|----------------------------|
| HMO  | Yes         | Yes                | Not usually; via PCP other.         | No                           | Typically lower                          | No                         |
| POS  | Yes         | Yes|Not usually.   | In-net: If required, likely via PCP.| Upon PCP referral.           | Typically lower in-net higher out-of-net | Only for out-of-net claims |
| EPO  | No          | No                 | Yes                                 | No                           | Typically lower                          | No                         |
| PPO  | No          | No                 | Yes                                 | Yes                          | Typically higher, esp. out-of-net        | Only for out-of-net claims |

Acronyms:

  • HMO = Health Maintenance Organization
  • POS = Point of Service
  • PPO = Preferred Provider Organization
  • EPO = Exclusive Provider Organization
  • PCP = Primary care physician (= General Practitioner / family doctor you go to)

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