Health Insurance

Other Types of Health Care Coverage

Traditional health insurance pays for things covered by your plan, like doctor’s fees, hospital bills, tests, and medicine. The coverages described below are meant to cover specific services only, provide coverage for a specific time, or are other options that are not insurance.

If you are considering any of these types of coverage, make sure to do your research. Ask questions to find out what they cost, what they pay for, and if they are good options for you.

*️⃣  To learn more about traditional health insurance, visit The Basics page.

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Other Insurance Types

Accident-Only Coverage. This pays a lump sum when the enrollee experiences death, dismemberment, disability, or hospital and medical care caused by an accident.

COBRA Coverage. When you lose or leave your job, you may be able to continue using your job-sponsored health care coverage through Consolidated Omnibus Budget Reconciliation Act (COBRA). For more info, read Choosing Health Care Coverage When You Lose or Leave Your Job.

Dental Coverage. You may buy separate coverage for your dental care. Dental care coverage often covers part of the cost of preventative care, fillings, crowns, root canals, and oral surgery. Plans may also cover orthodontics and dentures.

Disability Income Insurance. Insurance that gives income to people who can no longer work because of a disability. This insurance can help protect people from part of the short-term and long-term effects of income loss from being unable to work.

Fixed Indemnity Coverage. This insurance pays a fixed amount for certain procedures or for each day that you are in a hospital, instead of covering the entire amount.

Long-Term Care Insurance. Long-term care insurance usually pays for skilled, intermediate, and custodial care in your home, an adult daycare center, or assisted living facility. The policy usually pays a fixed amount per day while a person is receiving care. For more info, read Understanding the Basics of Long-Term Care.

Short-Term Limited Duration Insurance. This insurance covers some of the same services as traditional health insurance but does not have to offer a full set of essential health benefits. Plans typically cover a smaller share of the cost of services than traditional health insurance. That means you may pay less in premiums but may pay more when you need health care services. Plans may deny applicants or charge them more if they have pre-existing health conditions.

Specific Disease Coverage. This insurance only covers you if you are diagnosed with a disease outlined in the policy, such as cancer, Alzheimer’s disease, or heart disease.

Vision Coverage. You may buy separate coverage for your vision care. Vision care coverage often covers some portion of the cost of preventative care and prescription glasses or contacts. Plans may also cover corrective vision surgeries such as LASIK and PRK.

Other Options

The following options are NOT insurance. These options are not regulated by the Texas Department of Insurance (TDI) and are not backed by a guaranty association. This limits your protections, like the ability to file a complaint with TDI, get your claim paid, or get help if the entity becomes financially unstable.

Direct Primary Care Arrangements. Under these arrangements, a patient pays a regular fee to a physician for primary health care services. These arrangements may provide a large amount of personal attention for a relatively high cost.

Health Benefits Provided by Certain Nonprofit Agricultural Organizations (ex. Farm Bureau). Effective September 1, 2021, these health benefits may be offered to members of the organization and their families. These options may provide less coverage than traditional health insurance but can be less expensive.

Group Sharing. Under these arrangements, members pay a monthly fee. When they have health care expenses, members can request that the group or other members share part of the cost. However, the group is not legally obligated to pay for members’ health care costs. 

Health Sharing Ministries. Under these non-profit arrangements, members pay a monthly fee. When they have health care expenses, members can request that the ministry or other members share part of the cost. However, the ministry is not legally obligated to pay for members’ health care costs.

Terms to Know

Coinsurance – Coinsurance is the percentage of the cost you pay after you meet your deductible. 

Copayment (copay) – A copay is the fixed amount you must pay for a service covered by your plan. 

Coverage/Benefits – The health care services that the health plan will pay for if you get hurt or sick. Coverage and benefits can include preventive care.

Deductible – A deductible is what you pay every year before your health plan pays for most covered medical bills.

In-network – Health care services provided by a doctor or hospital that has an agreement with your health plan. You will usually pay less for in-network services.

Out-of-network – Health care services provided by a doctor or hospital that does not have an agreement with your health plan.

Policy – A contract between you and the insurance company. The policy tells you what’s covered and what the insurance company is required to pay.

Premium – A premium is a certain amount of money you pay each month for your health insurance.

Primary care physician (PCP) – Your personal doctor that provides basic health care services and coordinates your care by referring you to specialists.

Self-funded plans – Health plans operated by an employer (instead of the employer buying a health insurance plan). Self-funded plans are overseen by the U.S. Department of Labor.