Health Insurance Shopping Tips

Shopping for Coverage

  • Determine the coverage you want and need in a health plan. Choose the plan based on your needs. The higher a plan's deductibles, copays, and coinsurance, the lower the premiums but the more you'll have to pay out of your own pocket if you use benefits under the plan.
  • Consider factors other than cost. A carrier's financial rating and history of consumer complaints are other important considerations.
  • Make sure any person or organization you're using to buy insurance is either federally regulated or licensed in Texas. To ask about a navigator, assister, or counselor, call the federal health insurance marketplace at 1-800-318-2596. Make sure your agent or broker is licensed by TDI. Guaranty associations pay the claims of licensed insurance companies - but not HMOs -- that go bankrupt or become insolvent. If your carrier isn't licensed, your claims could go unpaid. You can learn a carrier's financial rating from an independent rating organization, its complaints history, and its license status by calling TDI's Consumer Help Line at 1-800-252-3439 or by viewing company profiles on our website at www.tdi.texas.gov.
  • Get several quotes and compare policies. When comparing prices, make sure you understand the benefits of each policy.
  • Visit TexasHealthOptions.com to find agents and carriers selling insurance in your area.
  • Visit HealthCare.gov to learn about the health insurance marketplace and to buy a marketplace plan. To get a subsidy that can help you pay for coverage, you have to buy your plan through the marketplace.
  • Beware of fake health insurance websites that might collect your personal information to commit identity theft.
  • Take your time. Don't be pressured into buying a policy. Ethical agents will not pressure you into buying a policy before you know what you want and need.
  • Be aware that while there will be a federal tax penalty for most people who don't have health insurance, no one should bill you for the tax penalty or try to collect it from you. If you owe a penalty, you'll pay it when you file your federal income taxes. You can't go to jail for not having insurance.
  • Ask your friends, family, and doctor for health plan recommendations. Ask these questions before buying a health plan:
    • Will the plan allow you to visit your choice of doctors and hospitals?
    • Are there limits on medications, referrals to specialists, or treatments and surgeries?
    • Are there benefit limits per person, family, illness, treatment, or hospital stay?
    • What are the rules for out-of-network care and emergency care?

Additional Precautions

  • Fill out all applications accurately and completely. If you knowingly provide incorrect, incomplete, or misleading information, especially about a preexisting condition, the carrier could cancel your coverage or deny benefits. Never sign a blank policy application, and check any information the agent fills in on the form. Make payments by check or money order payable directly to the insurance company or HMO, not the agent, and ask for a signed receipt on the carrier's letterhead.
  • Make sure you have the full name, address, and phone number of your agent and carrier. You can check an agent's or carrier's license status by calling the Consumer Help Line at 1-800-252-3439 or visiting our website at www.tdi.texas.gov.
  • Never pay more than two month's premiums until you have received a copy of your policy, HMO certificate, or group membership certificate.


For more information contact:

Last updated: 10/28/2015