Why choose UnitedHealthcare in Texas?
United Healthcare believes health coverage should be more than just a safety net—it should be a foundation for living a healthier life. As one of the nation’s leading health insurance providers, UHC is proud to offer plans in Texas that are designed with your needs in mind.
What Makes UnitedHealthcare Stand Out?
- Extensive Provider Network – Access to one of the largest networks of doctors, specialists, and hospitals in Texas and nationwide ensures you can find care when and where you need it.
- Comprehensive Coverage Options – Whether you’re looking for individual plans, family coverage, or Medicare solutions, UnitedHealthcare offers a range of plans tailored to fit your lifestyle and budget.
- Innovative Health Programs – From wellness incentives to virtual care and chronic condition management, UHC provide resources to help you stay healthy and save on out-of-pocket costs.
- Affordable Plans – Competitive rates and cost-saving tools make it easier to get the coverage you need without breaking the bank.
- 24/7 Support – UHC’s customer support team and digital tools are available around the clock to answer your questions and help you manage your plan.
United Healthcare Individual Exchange Plans:
- Have customized, focused networks of health care professionals
- Require that members have a primary care physician (PCP), or we’ll assign one to them
- Do require electronic referrals
- Have prior authorization and notification requirements
- Require that members pay the first month’s premium before coverage goes into effect
- Don’t cover services provided by out-of-network health care professionals, except for emergency services and relevant admissions we authorize
Why Texans Trust UnitedHealthcare
Living in Texas means access to unique lifestyles, vibrant communities, and diverse needs. UnitedHealthcare understands that one-size-fits-all insurance isn’t enough. That’s why our plans are tailored to meet the specific health needs of Texans—from families in the suburbs to individuals in bustling cities.
With UnitedHealthcare, you’re choosing more than insurance—you’re gaining a partner in health. Explore our plans today and see how UnitedHealthcare can help you live your healthiest life in the Lone Star State.
New for Texas in 2025
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New coverage areas
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Coverage in 4 new states: Indiana, Iowa, Nebraska and Wyoming
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Expansion into 119 new counties across 13 existing states
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- Plan updates
- Virtual plans will no longer be offered in 2025
- Adult Dental and Vision coverage expanded to all plans, including enhanced vision benefits
- Physical fitness access options available for all plans
- Resources available in Spanish on UHCprovider.com
- Interactive self-paced guide
- Quick reference guide
- Texas Exchange plans in Houston area using the Kelsey-Seybold Clinic network.
Network Changes from 2024 to 2025
- HCA locations out of network effective 1/1/2025
- Exiting Corpus Christi market effective 1/1/2025
- Baptist Saint Anthony’s added in 2024 (Amarillo)
- ETMC/UTHealth added 8/1/2024
- Additional providers pending
Narrow Network Texas plans
UHC is partnering with Kelsey-Seybold Clinic in the Houston area to offer Individual Exchange plans using a capitated arrangement in the Houston area.
Members will only have coverage within the Kelsey-Seybold network in the following counties:
- Brazoria
- Fort Bend
- Galveston
- Harris
- Montgomery
Members will have access to Kelsey-Seybold Clinic primary care physicians (PCPs) who will help them manage their care. We don’t require referrals for Kelsey-Seybold network providers. We require a referral for network specialists outside the clinic.
UHC Plan Overview
Plan Benefits and Features
UHC Plan benefits and features may include:
- $0 virtual urgent care visits
- Enhanced vision benefits, including polycarbonate lenses and increased allowance for frames
- Digital fitness classes at no additional cost
- Physical gym access at no additional cost for select plans
- Physical fitness access options available for all plans
- Prescription medication copays as low as $5 for Tier 1 generic drugs and $5 or less for Tier 2 generic drugs at Walgreens (zero cost share for Tier 1 preventive drugs)
- 20% off Walgreens-brand health and wellness products
- $150 gift card for completing certain wellness and digital engagement activities
Benefits and features may not be included in all plans*
Essetial Benefits
- Ambulatory patient services (e.g., outpatient)
- Emergency services
- Hospitalization (e.g., surgery and overnight stays)
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription Drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventative and wellness services and chronic disease management
- Pediatric services, including oral and vision care (note: Adult dental and vision coverage aren’t essential benefits)
- Virtual Visits: All Individual Exchange plans cover virtual visits.
- Some plans cover $0 copay virtual visits from designated providers
- For all plans, virtual visits from a non-designated provider is available at the cost share of the equivalent in-person service
- Virtual health includes behavioral health services.
- Optum-participating licensed therapists or psychiatrists can provide evaluation and treatment for behavioral health conditions.
Plan Names and Levels
Texas Plan Names and Coverage Levels
| Bronze | Silver | Gold | |
| Monthly Premium | $ | $$ | $$$ |
| Cost per visit/prescription | $$$$ | $$$ | $$ |
| Plan pays | 60% | 70% | 80% |
| Member pays | 40% | 30% | 20% |
Copay Focus (Bronze, Silver, Gold)
Higher premium plans with first dollar coverage and $0 medical deductible
Value (Bronze, Silver, Gold)
Go-to flagship plan, good fit for most, offered across all metal levels with both copays and coinsurance.
Advantage (Bronze, Silver, Gold)
Higher premium, with lower deductibles and cost shares. Adult Dental and Vision included with some plans.
Standard (Bronze, Silver, Gold)
Plan designs and cost-shares are prescribed, allowing consumers to more easily shop on price, network and product extras.
Essential (Bronze, Silver, Gold)
Lower premium, with higher deductible and cost shares at time of service. (Available off-exchange only)
Kelsey-Seybold
- Kelsey-Seybold Clinic providers are in-network for this plan and members have an assigned PCP from the clinic network
- Available in the Texas counties of Brazoria, Fort Bend, Galveston, Harris, Montgomery and Walker
PCP Information
Members must have an assigned PCP to help them manage their health care:
- Members must select a PCP at the time of enrollment
- If a member doesn’t select a PCP within the first month, we’ll assign one
- Family members on the same plan may have different PCPs
How to change the PCP:
- We allow members to change their PCP once a month by
- Calling the Member Services number on their ID card
- Submitting a PCP change request at myuhc.com
- Physicians may also submit PCP change requests for their patients who are members
Prescriptions / Drugs
Texas 2025 Benefit Grid
Bronze
| Plan Name | Deductible (Ind/Fam) | Max OOO (Ind/Fam) | PCP Visit | Metal Health Visit | Specialist |
| UHC Bronze Standard | $7,500 / $15,000 | $9,200 / $18,400 | $50 | $50 | $100 |
| UHC Bronze Value | $8,250 / $16,500 | $9,200 / $18,400 | $25 | 40% | 40% |
| UHC Copay Focus $0 | $0 / $0 | $9,200 / $18,400 | $40 | $40 | $150 |
| UHC Kelsey-Seybold Bronze | $0 / $0 | $9,200 / $18,400 | $40 | $40 | $150 |
Silver
| Plan Name | Deductible (Ind/Fam) | Max OOO (Ind/Fam) | PCP Visit | Metal Health Visit | Specialist |
| UHC Silver Standard | $5,000 / $10,000 | $8,000 / $16,000 | $40 | $40 | $80 |
| UHC Silver Value | $3,000 / $6,000 | $9,200 / $18,400 | $15 | 40% | 40% |
| UHC Kelsey-Seybold Silver | $0 / $0 | $9,200 / $18,400 | $15 | $30 | $75 |
Gold
| Plan Name | Deductible (Ind/Fam) | Max OOO (Ind/Fam) | PCP Visit | Metal Health Visit | Specialist |
| UHC Gold Standard | $1,500 / $3,000 | $7,800 / $15,600 | $30 | $30 | $60 |
| UHC Gold Advantage | $500 / $1,000 | $7,000 / $14,000 | $5 | $5 | $75 |
| UHC Kelsey-Seybold Gold | $0 / $0 | $7,000 / $14,000 | $10 | $20 | $40 |
*benefits subject to change depending on the carrier
Coverage by Market Area (Areas de mercado)
Amarillo Network Coverage
Counties:
- Armstrong
- Briscoe
- Carson
- Castro
- Childress
- Collingsworth
- Dallam
- Deaf
- Smith
- Donley
- Gray
- Hall
- Hansford
- Hartley
- Hemphill
- Hutchinson
- Lipscomb
- Moore
- Ochiltree
- Oldham
- Parmer
- Potter
- Randall
- Roberts
- Sherman
- Swisher
- Wheeler
Hospitals and Employed Providers:
- Baptist Saint Anthony’s Health System:
- BSA Hospital
- Physicians Surgical Hospital
- Childress Regional Medical Center
- Collingsworth General Hospital
- Coon Memorial Hospital
- Golden Plains Community Hospital
- Hansford County Hospital
- Hemphill County Hospital District
- Hereford Regional Medical Center
Moore County Hospital District
- Northwest Texas Healthcare System:
- Ochiltree General Hospital
- Pampa Regional Medical Center
- Parkview Hospital
- Parmer County Community Hospital
- Plains Memorial Hospital
- Shamrock General Hospital
- Swisher Memorial Healthcare System
Austin Network Coverage
Counties:
- Blanco
- Burnet
- Caldwell
- Fayette
- Hays
- Lee
- Llano
- Travis
- Williamson
Hospitals and Employed Providers:
- Central Texas Rehab Hospital
- Cornerstone Specialty Hospitals Austin/Round Rock
- Neuro Institute of Austin
- Pam Rehab Hospital of Round Rock
- Warm Springs Rehab and Specialty Hospitals
- Additional providers pending
- Austin Regional Clinic
Beaumont Network Coverage
Counties:
- Angelina
- Hardin
- Houston
- Jasper
- Jefferson
- Nacogdoches
- Newton
- Orange
- Polk
- Sabine
- San Augustine
- San Jacinto
- Shelby
- Trinity
- Tyler
Hospitals and Employed Providers:
- Baptist Hospitals of Southeast Texas:
- Baptist Beaumont Hospital
- Crockett Medical Center
- Medical Center of SE Texas/Permian Premier Physicians
- Sabine County Hospital
- Tyler County Hospital
- CHI St. Lukes Health Memorial,
- Memorial Livingston,
- Memorial St. Augustine
- Tenet Healthcare:
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- Nacogdoches Medical Center Hospital
Brownsville Network Coverage
Counties:
- Cameron
- Kenedy
- Willacy
Hospitals and Employed Providers:
- Valley Baptist Health System (Tenet):
- Valley Baptist Medical Center –Brownsville
- Valley Baptist Medical Harlingen
College Station Network Coverage
Counties:
- Brazos
- Burleson
- Grimes
- Leon
- Madison
- Milam
- Robertson
Hospitals and Employed Providers:
- CHI St. Joseph Health System:
- CHI St. Joseph Health Burleson Hospital
- CHI St. Joseph Health College Station Hospital
- CHI St. Joseph Health Grimes Hospital
- CHI St. Joseph Health Madison Hospital
- CHI St. Joseph Health Regional Hospital
- CHI St. Joseph Regional Rehabilitation Center
- CHI St. Joseph Health Rehabilitation Hospital
- Also Available:
- Limestone Medical Center
- Freestone Medical Center
- Falls Community Hospital
- Parkview Regional Hospital