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All You Need to Know About Small Business Health Insurance in Texas



55% of employers with fewer than 100 employees offer health insurance despite it being legally required under the Affordable Care Act for businesses with more than 50 employees. Despite the legal requirements, it’s a massive perk for small businesses looking to attract top talent.

Are you a small business owner in Texas looking to ensure your employees have access to quality health insurance? We’ve got you covered. 

This comprehensive guide will break down the ins and outs of obtaining small business health insurance in Texas, from understanding the different types of coverage available to navigating state regulations and more.

With helpful tips and resources tailored just for businesses located in Texas, consider this as your starting place towards ensuring that both you and your employees enjoy peace of mind when it comes to health insurance.

Is Small Business Health Insurance in Texas Mandatory?

It depends on how many employees you have. As mentioned above, under the Affordable Care Act, any employer with more than 50 employees must offer affordable health insurance. This isn’t a Texas law; it’s a federal law.

As part of this mandate, if you offer health insurance, you must offer it to all eligible employees as soon as they become eligible for coverage. This means you can’t discriminate between employees and offer coverage to certain ones without reason. It’s important to note that the eligibility period can’t extend beyond 90 days either.

What qualifies as an “eligible employee?” Typically, in Texas, anybody works for your small business for at least 30 hours a week. They also need to work year-round, so you don’t have to offer Texas health insurance to seasonal employees, for example.

But what if you have less than 50 employees? You’re not required to offer anything and won’t get in legal trouble for not doing so. Still, it’s highly recommended. We’ll jump into the details of why below.

Finally, a law states that you, as the small business owner, don’t legally have to share the cost of health plan premiums. With that in mind, certain insurance companies will require you to pay a part of your employees’ premiums. However, that’s up to the insurance companies.

Benefits of Texas Health Insurance

While you might not be required to offer a group insurance plan or any sort of health plan, doing so greatly benefits your bottom line as a business owner. Don’t believe us? Just check out these four great benefits of investing in small business health insurance in Texas.

Reduces Absenteeism

When employees have access to preventive care and other services through insurance, they are more likely to stay on top of their health, reducing the number of days they will need off due to illness or injury. Additionally, when you help reduce financial strain by providing health insurance, your employees are less likely to take excessive time away from work due to medical-related expenses.

Boosts Productivity

One study found that healthy workers were three times more productive than those with poor health. Simply put, investing in health insurance is great for your employees and your company’s productivity rates. With their basic needs taken care of, they’re able to focus more on favorable working conditions, resulting in higher staff morale and better performance levels.

Attracts Top Talent

What’s the number one job perk employees look for these days? You guessed it. It’s employer-sponsored healthcare. 68% of employees want this as part of their job, and in today’s hiring landscape, you want to offer the best perks to be able to attract top talent.

Provides Tax Credits

Lastly, you can actually receive a tax credit by offering insurance plans for your employees. It’s part of the Small Business Health Care Tax Credit, and it’s worth up to 50% of the total cost you pay for the premiums. You have to meet a few requirements to qualify for this, however.

Namely, this tax credit is specifically designed for employers with fewer than 25 full-time employees. However, if you qualify, it’s a great way to reduce your business tax bill yearly while offering an attractive perk to top talent.

Texas Health Insurance Options

What are your options as you start to search for small business health insurance in Texas? You don’t have to purchase health insurance from specific insurance companies. However, there are two main types of health insurance plans most small business owners opt for in these situations.

Individual Insurance Plan

These are ideal insurance plans for business owners with no employees. For example, let’s say you own a content creation agency. You have a Texas-registered LLC, and you outsource some of your content creation work to freelancers but don’t have full-time employees. In this case, an individual health insurance plan would be ideal for you and your family.

Is this necessary? Not technically, no. However, it’s incredibly important these days. Private health insurance can protect you against financial hardship due to high medical bills. Plus, anyone can apply for individual health insurance.

They’re also a great option for small business owners who cannot meet minimum participation requirements for group coverage or for those who are self-employed. It’s worth noting that individual health insurance benefits can be tax deductible, making out-of-pocket costs even lower.

Furthermore, individual health insurance plans give you control and flexibility over your coverage. With individual health insurance, you can tailor your policy to fit your unique needs and circumstances. As you grow personally and professionally, keeping up with your ever-changing lifestyle is easier.

Group Insurance Plan

If you do have employees, you’ll likely want to look into a group health insurance plan. Group health insurance plans are a fantastic way for employers to provide benefits while staying within budget. By sharing costs between the employer and employee, group health insurance plans are cost-effective and easily accessible.

Furthermore, group health insurance plans often extend coverage to dependents. This means they can look after their loved ones without worrying about costs. All in all, group health insurance plans balance quality and affordability for small business owners.

Types of Texas Health Insurance Plans

Now that you know what kind of health insurance you might need to look for as a business owner in Texas, what are the most popular plans? Again, you can often customize your health plans to fit your coverage needs and budget these days. However, here are four popular types of Texas health insurance plans to consider.

PPO Health Insurance

PPO plans are Preferred Provider Organization plans. They allow employees to visit any doctor or hospital on the insurance company’s list of preferred providers. This ensures that their claims are paid at the highest level.

PPOs are great for business owners because they don’t limit coverage only to certain doctors and hospitals like HMOs do. Plus, PPOs offer various benefits and help small business owners save money. However, the benefits depend on the type of coverage you need and how many employees you have.

Ultimately, PPO health insurance plans provide flexibility, cost savings, and reliability, with little to no risk on the business owner’s part. This makes them an excellent choice in today’s competitive market.

HMO Health Insurance

HMO stands for “Health Maintenance Organization.” HMO plans feature a vast network of contracted providers. This includes primary care physicians (PCPs) who can direct members to HMO specialists for more in-depth care if needed.

Additionally, HMO plans are relatively simple and straightforward. As a business owner, this means fewer headaches and confusion. Forget about navigating coverage and paperwork. HMO health insurance plans offer a solid balance between cost and quality of health care services.

Sure, they’re somewhat less flexible than PPO plans. However, they’re most cost-effective in the long run for you.

HSA-Qualified Health Insurance

HSA refers to the Health Savings Plan. These PPO plans are designed for use with a Health Savings Account. This means participants can save pre-tax money and use it for medical expenses later.

For employers, HSA-qualified plans can be further enhanced using Section 105 Healthcare Reimbursement Plans (HRPs). HRPs provide even more advantages. Among them are increased savings and keeping HSA funds in the employer’s hands. However, keep in mind that the contribution limits are somewhat low.

Short-Term Health Insurance

Finally, you might want to consider short-term health insurance. This is ideal for solo business owners in need of temporary health insurance. It’s also ideal for small business owners who can’t offer health insurance to their employees but want to recommend an affordable option they can purchase on their own.

You can secure up to $2 million of coverage with short-term health plans. They’re designed to cover short-term gaps such as furloughs or job changes. It’s a highly flexible option that offers coverage terms, deductibles, and payment options specific to your individual needs.

Plus, you can get started soon after signing up. Most short-term health insurers will have your policy in compliance within 24 hours. Moreover, short-term health insurance is much more affordable than typical health plans.

The trade-off is that the coverage is short-term, obviously. However, if you’re in good health, it’s a great option for you (and a great one to recommend to employees who might need it).

What About Health Sharing Plans?

You might have heard of another option referred to as a “health sharing plan” or a “health share plan.” With this type of health coverage, members must pay a monthly share. They also pay an annual unshared out-of-pocket amount before the plan covers any associated medical expenses.

The biggest benefit?

Health sharing plans let you opt out of certain services you wouldn’t use, so you save money on your premiums. Furthermore, health share plans offer entry into health care coverage with a basic list of included services which is great if you don’t need all the extras that usually come with traditional health insurance.

However, that doesn’t make them the right option for small business owners or their employees. In fact, they’re not technically health insurance plans at all.

Instead of relying entirely on a health insurance company, health-share plans have members pay for some expenses directly from each other. Though this might sound intriguing, these plans usually don’t cover wellness visits or preventive care.

Members are responsible for funding those with their own money. Additionally, they rarely offer coverage for dental or vision care either. Lastly, remember that health share plans typically come with restrictions on pre-existing conditions. This isn’t currently allowed for regular health insurance plans under the ACA.

Group Health Insurance Brokers in Texas

A group insurance plan is the best option for small business owners looking to cover their employees for a few simple reasons. Firstly, group health insurance policies are usually more cost-effective than individual policies. Group rates offer significant discounts compared to what individual members would pay.


Additionally, group policies provide greater coverage options. These options span from costs such as prescriptions and preventative care to coverage of long-term disabilities. Sounds great, right? It doesn’t stop there.


Finally, group health insurance is much easier to manage than individual plans. There’s no need to assess or process numerous applications when adding new employees. A group policy covers everyone employed by the business owner at one flat rate.


Does this mean you need to find a group health insurance broker immediately? You don’t technically need a broker to purchase group health insurance in Texas. However, we do recommend it. Licensed Health insurance brokers understand the ins and outs of business insurance, including the following:
  • Evaluating independent health insurance providers
  • Expertise in plan underwriting
  • Processing health insurance claims
  • Easy online applications

There’s more to it than that. However, you (hopefully) get the point. Working with an experienced broker can make all the difference.

Get a Quote

Ready to explore your options for small business health insurance in Texas? We’re here to help! We have over 60 years of experience serving customers looking for quality health insurance at Custom Health Plans.

To start the process, click here to get a free quote. Or, feel free to contact us to chat about your small business needs and how we can customize a plan to fit them. 

#Small #Business #Health #Insurance #Texas

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What is the Medicare Part D coverage gap? REMEDIGAP





In the world of Medicare, there exists a peculiar term called the “donut hole.” No, we are not referring to the sweet, deep-fried confectionery that tempts our taste buds. Instead, the doughnut hole refers to a unique coverage gap in the Medicare Part D drug plan (Medicare’s prescription drug program). Understanding this concept is essential for those relying on Medicare for their healthcare needs. That’s because it directly impacts out-of-pocket expenses for prescription medications.

Medicare Part D Donut Hole

The donut hole is a phase within your Medicare Part DD prescription drug coverage (It is not related to medications that are covered under your Medicare Part B). It is where beneficiaries must bear a more significant portion of their prescription costs. It is a point in your drug coverage, marked by a specific dollar amount. Once you spend a certain amount on medications and reach a certain threshold, beneficiaries enter the “donut-hole”. This is where they are responsible for a higher percentage of costs until they reach the next threshold.

Though the concept may appear confusing at first. Being aware of it is paramount for beneficiaries to effectively manage their healthcare costs. It will also help them make informed decisions regarding drug coverage. Let’s dive a little deeper into the specifics and how it affects beneficiaries.

When do you enter the donut hole?

The donut hole begins once the total amount spent on covered drugs by both the person and their insurance plan reaches a certain threshold. At this point, the individual enters the initial coverage stage. In other words, you’re in the donut hole. This is where you’re responsible for paying 25% of the cost for brand-name drugs and 25% of the cost for generic drugs (the drug manufacturer pays 75%).

It is important to note that the cost that applies towards reaching the threshold includes the following: The amount paid by the person and any drug manufacturer discounts received for brand-name drugs.

Once the individual reaches the catastrophic coverage threshold, their out-of-pocket costs decrease significantly. It is crucial for individuals enrolled in Medicare drug plans to be aware of this and plan their medication expenses accordingly.

When do you get out of the donut hole?

Once you exceed the threshold of cost, you will be out of the “donut-hole” and you’ll enter the catastrophic coverage phase. When closing the donut-hole, it’s important to note that not all expenses count towards reaching the threshold.

For example, Part D premiums don’t help you with this coverage phase. Payments made by your drug plan and manufacturer discounts are among the costs that don’t contribute to reaching the out-of-pocket limit.

How to avoid the Medicare donut hole?

Navigating the complex landscape of Medicare can be overwhelming. However, there are strategies to help minimize the impact. One approach is to carefully select a Medicare Part D coverage plan and review its costs. Comparing different Medicare plans and understanding their formulary can allow beneficiaries to determine which plan provides the most comprehensive Medicare Part D coverage for their specific medication needs.

Another way to avoid the donut-hole is to take advantage of cost-saving initiatives, such as generic drugs or mail-order pharmacy services. By opting for lower-cost alternatives and prescription delivery services, beneficiaries can stretch their medication budget. This can potentially delay reaching the threshold. It is also crucial for individuals to monitor their medication usage throughout the year and be aware of their total costs. Tracking expenses and consulting with a Medicare expert can ensure beneficiaries stay informed. It helps to take these necessary steps to avoid falling into the Medicare donut-hole.

When is the Medicare Donut Hole Closed?

In the past, beneficiaries had to cover the full cost of their medications while in the gap. However, with the passing of the Affordable Care Act in 2010, a plan was put into motion to close this gap in coverage completely. This plan aims to reduce the out-of-pocket costs for beneficiaries during the Medicare prescription drug coverage gap.

The closure is being phased in over several years, with incremental improvements each year. In the coming years, it is expected that it will be completely closed. This means that beneficiaries will no longer have to pay the higher percentage of their covered prescription drug costs out-of-pocket while in the gap. Instead, they will pay a lower percentage, making their medications more affordable and accessible.

Will the Prescription Drug Part D Coverage Gap Go Away?

The future of the Part D prescription drug plan gap is a popular topic. Originally, the gap was implemented as a cost-saving measure and was intended to encourage individuals to use generic drugs, thus reducing overall healthcare expenditures. However, over the years, this has proven to be a burden for many Medicare beneficiaries, who face significant out-of-pocket costs when they fall into this gap. As a result, there have been ongoing discussions about the need to eliminate or modify this coverage gap stage.

The good news for 2023 is that the coverage gap phase is set to be fully eliminated in 2025. This means that Part D enrollees will no longer face heightened costs during this phase. Instead, they will continue to pay their regular cost-sharing amounts for prescription drugs throughout the year.

The elimination of the Medicare coverage gap phase is a significant improvement for beneficiaries. It removes a financial burden that many have faced in the past and aligns with the goal of providing more affordable access to necessary medications. Click here to learn more about Medicare Part D plans.

How does donut hole work with Medicare Advantage & Medicare Part D costs?

The donut-hole is also connected to Medicare Advantage plans that have a Part drug plan. These plans are also known as MAPD plans or Part-C.

MAPD plans, which are private insurance plans that provide Medicare benefits, often include Part DD plan drug coverage as part of their offerings. Therefore, it can also apply to those enrolled in MAPD plans. Since these plans often include drug coverage as part of their offerings, the coverage gap commonly can also apply to those enrolled in these plans. Click here to learn more about the Medicare Part-C program.


Out-of-pocket drug costs can take a toll on your wallet. Whether you have a Medicare Supplement insurance plan or an MAPD plan, your annual drug costs can be significant. Even if you don’t take any medications today, you should still get a Part-D plan to avoid a penalty. However, if you take medications and fill a prescription, your Part-DD plan should keep your overall costs lower compared to not having one.

It’s understandable if all of this is overwhelming. That’s why we created an easy to learn course to get you familiar with the Medicare system. People with Medicare rave about our free course.  The free course provides additional information about the different parts of Medicare, enrollment, costs, what Medicare pays and what it won’t and more.


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Judge dismisses Republican lawsuit against Google over Gmail’s spam filtering




The suit complained Google intentionally sent RNC political emails to Gmail users’ spam folders, and the RNC sought restitution for “donations it allegedly lost as a result” of those lost emails. The RNC cited a North Carolina State University study that found Gmail was more likely to mark emails from Republican campaigns as spam. One of the study’s authors spoke to the Post in May last year, saying its findings had been misrepresented. Muhammad Shahzad noted that it only tested default email settings — in tests on accounts where users indicated their preferences by marking some messages as spam, “the biases in Gmail almost disappeared.”

While US District Court Judge Daniel Calabretta described the RNC’s suit as a “close case,” he dismissed the Committee’s claims, writing that it had “failed to plausibly allege its claims” that Google’s filtering was done in bad faith. Google claimed that many of the filtered emails were likely picked up by its spam algorithms because of user complaints and pointed to problems with the RNC’s domain authentication and frequent emails as other culprits.

The judge also said Republican emails could be considered “objectionable” content based on the definition in the CAN-SPAM Act and said that Google designating them spam is protected by section 230 of the Communications Decency Act. The decision left Republicans with partial “leave to amend to establish a lack of good faith” on Google’s part.

#Judge #dismisses #Republican #lawsuit #Google #Gmails #spam #filtering

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Transparency in Coverage – price information accessible to the public




Are you ready to take charge of your healthcare like never before? In 2023 insurance carriers are rolling out an online price transparency tool available for 500 shoppable items and services. In compliance with Transparency in Coverage, subsequently implemented under the Affordable Care Act (ACA) of 2020.

Say goodbye to the days of uncertainty and hidden fees! With this tool, you’ll clearly understand what to expect, allowing you to plan and budget for your healthcare like a pro.

It’s a game-changer! You are finally able to inform yourself about the cost of that medical procedure you’ve been considering. Curious about the price of a specific service? An internet-based price comparison tool that allows an individual to receive an estimate of their cost-sharing responsibility for a specific item or service from a specific provider. You can even request the same information over the phone by calling your insurance membership line.

We can’t stress enough how important it is for you to sign up with your provider’s member portal. It will help you to maximize your coverage and will provide you the power to manage your account seamlessly. In addition to accessing your explanation of the benefits of your past procedures, you will see how much you have paid towards the deductible and out-of-pocket maximum, you will be able to locate providers and hospitals in your network, be able to see your policy payment status, pay your premium online and also now be able to find the treatment cost estimator.

Blue Shield of California

Treatment Cost Estimator is a new tool already available for Blue Shield members. This calculates the overall cost and out-of-pocket expenses for frequent in-network medical procedures. Moreover, projections offer the members of transparency and clarity they need to budget and make future healthcare plans. Click 👇 here to view Blue Shield treatment cost estimator brochure.


Here’s for Kaiser members. Log in to your member portal, then click on the “benefits” tab. Scroll down, and subsequently, you will find the “Find cost estimates” section. The list of procedures is clickable therefore you can click on each to see their estimates.

kaiser member page


Anthem members should go and log on to Once the member logs on, they will click on “Care” at the top of the site; lastly, they will need to “Shop for Procedure”. You should be able to find the information you need.

LA Care

With LA Care’s utmost security over the phone, each member is welcome to call member services at 855-270-2327 to walk you through navigating the portal.


To make the most of your membership benefits, don’t forget to log in to your personalized Member Portal at It’s your gateway to a world of convenience and control over your insurance needs.

In addition, you have access to a dedicated Concierge team ready to assist you with any insurance-related inquiries. Simply give them a call at 855-672-2755 (opt#2), and they’ll be more than happy to walk you through this feature.

You can also contact your Care Team through direct messaging at [email protected]. Remember to include your OSC# and provide all the details to ensure a swift and accurate response.

Utilizing these cost estimation tools can save time and effort in understanding your health coverage costs. You will no longer have to spend hours poring over complicated insurance documents or making numerous phone calls to your insurance provider. Instead, you can access all the information you need at your fingertips and make informed decisions about your healthcare.

If you would like to discuss your health insurance options with a personal touch, feel free to reach out to us at 310-909-6135 or send us an email at [email protected]. We are here to provide dedicated assistance in safeguarding your future and protecting your loved ones today.

#Transparency #Coverage #price #information #accessible #public

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