Selecting a health plan in Texas

Question

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.

Answer 1

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.

Answer 2

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).

Answer 3

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
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)