PPO: Preferred Provider Organization.

A PPO allows you the freedom to choose your own doctors and facilities. Even if the doctor or facility is not in-network, the insurance is still responsible for their portion. A PPO also allows you to go straight to a specialist without requiring a referral from a Primary Care Physician.

HMO: Health Maintenance Organization.

A HMO may only give access to a limited number of doctors and facilities in its small network. If one seeks care out-of-network then the insurance company may not be responsible for any of the bill unless deemed a life-threatening emergency. A HMO typically requires you to have a referral from your Primary Care Physician before being able to see a specialist.

Short answer, YES!

When enrolling into the Affordable Care Act/Marketplace, one must either qualify for a Special Enrollment Period or be in the state’s Open Enrollment window. Open Enrollment in Texas is November 1st to December 15th and the plans would begin on January 1st of the following year.

Private insurance is not regulated through the government. Most private plans are available year round and not primarily based on your income.

Outside of an employer, health insurance rates are primarily based off of the zip code, age, health and gender of everyone on the plan.