What is Comprehensive Health Insurance? A Guide to Comprehensive Healthcare in Texas.
9 Minutes
Team Curative
Feb 22, 2024
When choosing insurance options for your company, it is crucial to understand your region's needs and the insurance option that best provides comprehensive healthcare access. Let’s face it – health insurance can be tricky. How do employers determine the best insurance plan for their company’s talent? What unique health challenges do residents in Texas face? We’ve all heard of “comprehensive health insurance,” but what does this really mean? Here’s how to identify the best health insurance Texas companies can offer their workforce.
What is comprehensive health insurance coverage?
Comprehensive insurance refers to health insurance plans that cover a variety of healthcare services. This plan is commonly called major medical insurance and provides coverage for most medical services and procedures in addition to preventive care.
Comprehensive health insurance coverage should include:
Preventative care: regular screenings, check-ups, and vaccinations
Hospital care: in-patient stays, surgery, medication, and hospital services
Emergency services: unexpected trips for emergency evaluation and treatment
Prescription medication: coverage of all or a portion of the cost of prescription drugs
Mental health and addiction treatment: counseling, therapy, rehabilitation, and medication
Maternity and newborn care: prenatal and postnatal care for both the mother and baby
The State of Health in Texas
Texas is an incredibly diverse state with a large population and vibrant cultures. The Lone Star State is home to more than 30 million people, according to the 2022 United States Census. Accordingly, health needs vary throughout Texas by both population and region.
To better understand Texas employees' health insurance needs, Curative surveyed the four largest metropolitan areas in Texas: San Antonio, Houston, Austin, and Dallas-Fort Worth.
Here are some of the main takeaways:
34% are dissatisfied with unaffordable out-of-pocket health insurance costs.
59% have difficulty paying out-of-pocket healthcare expenses because their deductible is too high.
Less than half (48%) say they could afford their out-of-pocket costs if they had a major medical event or were diagnosed with a chronic illness.
51% said the health benefits package offered by their place of employment influenced their decision to work there.
Many employees face a difficult decision: forgo or delay medical care, resulting in worse health outcomes and work performance, or experience financial stress to pay for necessary medical treatment. Texas employers need a comprehensive coverage health insurance plan to meet the needs of their hardworking employees.
In an alarming trend, women’s health and mental health are ranked worse in Texas than nearly any other state. Texas ranked 49th in reproductive and women’s health in the 50 states and the District of Columbia. According to Mental Health America's annual rankings, Texas ranks 50th out of the 50 states and the District of Columbia in overall access to mental healthcare. Mental health has been shown essential to the success of both the employee and the business. By offering comprehensive coverage, employers increase access to women’s healthcare and mental healthcare.
The need for readily available healthcare continues to be a problem throughout Texas. Health insurance plans will determine which providers can be covered. Texas ranked 7th to last among all states in a healthcare access and quality index produced by Wallethub. Restrictive insurance plans limit access further by only allowing members to see a portion of the available providers.
Local and National Providers
Curative offers access to an extensive selection of providers in Texas and across the United States. With access to one million professional providers and eight thousand hospitals, members can choose the best primary care and specialty providers to meet their unique health needs.
First Health® providers are now in-network for our members. This means patients can search for the doctor of their choice using Curative’s provider search tool to make sure they are in-network.
Curative makes access affordable. After a Baseline Visit*, members will have $0 copay fees for in-network family practice, internal medicine, OB/GYN, and pediatric appointments. Additionally, there is no copay required for in-network emergency room visits, urgent care, and specialist offices.
To supplement our extensive network of providers, we're offering access to Curative Primary Care, a medical group fully dedicated to Curative members so they can be seen more quickly and without concerns over costs. Currently available in Texas only.
You also have the option to see a doctor without leaving your home! Curative allows members to have 24/7/365 access to a local physician via virtual urgent care.
Does insurance cover prescription drugs?
Employer-based health insurance plans generally provide coverage for prescription drugs, but the extent of coverage can vary widely depending on the specific plan. Fees for prescriptions will vary depending on the plan’s copay and out-of-pocket policies.
A copayment, often called a copay, is a predetermined, fixed amount of money an insured individual pays for a medical service or prescription. Health insurance pays for a portion of the medicine or medical service cost; the individual is responsible for the remainder. For example, a health insurance plan may specify a $20 copay for an office visit to a primary care provider or a $10 copay for generic prescription drugs.
Some insurance companies, like Curative, offer prescription delivery services as part of a comprehensive healthcare program, making filling and receiving medication even easier. Delivery options increase medication access and remove common barriers to filling prescriptions, such as time constraints and transportation limitations.
Curative members have access to $0 drug options for nearly every condition through our network of pharmacy partners and our exceptional Curative Pharmacy. The Curative Pharmacy offers medication delivery as soon as the next day in select cities in the Austin, Dallas, Houston, and San Antonio areas. Rapid delivery is available across the remaining Texas geographies.
Does insurance cover specialist visits?
In most cases, health insurance will cover specialist visits. However, as with prescription drugs, coverage will vary depending on the scope and type of the individual plan. Even if the specialist visit is covered, a copay may be required for the visit, along with any medical procedures.
Some health insurance plans require a primary care provider referral before seeing the specialist. This means that, to have insurance cover the visit, a primary care provider will need to verify that a specialist is needed based on the symptoms or conditions of the patient.
Insurance plans often have a network of healthcare providers, including specialists. Visiting an in-network specialist generally results in lower out-of-pocket costs for the patient. Going to an out-of-network specialist may lead to higher costs, and in some cases, the visit is not covered.
Some insurance plans limit the number of specialist visits within a specific time frame. Often, health insurance plans will have an annual limit on the number of times you can receive care from a certain type of specialist, and may even vary based on the specific services offered.
Does insurance cover COVID-19 testing and vaccines?
For the most part, health insurance policies typically cover COVID-19 testing and vaccines as part of their comprehensive healthcare programs.
Over-the-counter COVID-19 tests will be covered through most insurance policies, though a small copay may be required, or the number of tests provided may be limited. The federal government has strongly incentivized health plans and insurers to cover the upfront costs of at-home COVID-19 testing, meaning that most people with private insurance will have no fee when purchasing a test at a pharmacy or store. Depending on your plan, over-the-counter COVID-19 tests may either be free directly at the point of sale or be reimbursed by your health insurance company.
Free COVID-19 testing is readily available to everyone in the United States, including those without insurance. For a complete list of COVID-19 testing locations, please visit the U.S. Department of Health and Human Services. Additionally, insurance companies have partnered with pharmacies and medical offices to provide free or low-cost COVID-19 testing.
COVID-19 vaccines will remain accessible to those with private and public health insurance plans. There are no out-of-pocket costs for members for COVID-19 vaccines; no deductible or copay will be charged for the medication or administration of the vaccine.
Curative has mastered the art of comprehensive healthcare
Curative is a new kind of employer-sponsored health insurance that provides comprehensive healthcare while prioritizing affordability, engagement, and simplicity.
Curative has mastered the art of the comprehensive health insurance plan. Members experience $0 copays and $0 out-of-pocket costs. Curative has a broad provider network that allows easy access to convenient doctors and facilities.
Curative wants people to love using their health benefits. Our plans go beyond the standard coverage by focusing on wellness, preventive care, and improved health outcomes. The Curative solution delivers better health through affordability, engagement, and simplicity.
No copays. No deductibles. No...really. Curative is changing the way we view health insurance.
Learn more about how Curative can help you find your organization's best comprehensive healthcare plans by visiting our website today.
To see all disclaimers, please view here.
References
(ASH), A. S. for H. (2023, November 20). Community-based testing sites for covid-19. HHS.gov. https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html
Odom, A. (2023, August 2). U.S. study ranks Texas as 7th Worst State for Health Care. U.S. study ranks Texas as 7th worst state with health care. https://spectrumlocalnews.com/tx/south-texas-el-paso/news/2023/08/02/u-s--study-ranks-texas-as-7th-worst-state-with-health-care
Price, S. (2022, March 29). Texas has spent more on prescription drugs than any state since 2019. Beaumont Enterprise. https://www.beaumontenterprise.com/news/article/Texas-has-spent-the-most-on-prescription-17036343.php
Simon, S. (2022, June 4). Texas ranks last in mental health care among U.S. states. NPR. https://www.npr.org/2022/06/04/1103075887/texas-ranks-last-in-mental-health-care-among-u-s-states
Total diabetes deaths by race/ethnicity. KFF. (2023, May 15). https://www.kff.org/other/state-indicator/diabetes-death-rate-by-raceethnicity/
Wolf, M. (2023, June 23). Texas ranks 49th for Women’s Health in new state-by-state scorecard. Dallas News. https://www.dallasnews.com/news/public-health/2023/06/22/texas-ranks-49th-for-womens-health-in-new-state-by-state-scorecard/
