Insurance, copays and prices in plain words
Search the plans we work with, learn what a copay is, and see what a visit costs if you do not use insurance.
Find your plan
“In network” means we have an agreement with the plan, so your costs are lower. “Limited network” means some of our providers are covered. Call billing to check yours.
Showing all 40 plans.
Armadillo Family Marketplace Gold
Armadillo Family Health
MarketplaceIn network
All Alder Health services are covered in network.
Armadillo Family Marketplace Silver
Armadillo Family Health
MarketplaceIn network
Checkups are covered before your deductible.
Armadillo Family PPO
Armadillo Family Health
PPOIn network
No referral needed to see a specialist.
Blackland Prairie HMO
Blackland Prairie Health
HMOIn network
A referral from your primary care provider is needed for specialists.
Blackland Prairie Marketplace Bronze
Blackland Prairie Health
MarketplaceLimited network
In network for checkups and vaccines. Other visits need a quick check of your benefits.
Blackland Prairie PPO
Blackland Prairie Health
PPOIn network
No referral needed to see a specialist.
Bluebonnet HMO
Bluebonnet Health Plan
HMOIn network
A referral from your primary care provider is needed for specialists.
Bluebonnet Marketplace Gold
Bluebonnet Health Plan
MarketplaceIn network
All Alder Health services are covered in network.
Bluebonnet Marketplace Silver
Bluebonnet Health Plan
MarketplaceIn network
Checkups are covered before your deductible.
Bluebonnet PPO
Bluebonnet Health Plan
PPOIn network
No referral needed to see a specialist.
Capital City Care EPO
Capital City Care
EPOIn network
In network only. Out of network visits are not covered.
Capital City Care HMO
Capital City Care
HMOIn network
A referral from your primary care provider is needed for specialists.
Capital City Care Marketplace Bronze
Capital City Care
MarketplaceIn network
You pay the full visit price until your deductible is met.
Cedar Ridge EPO
Cedar Ridge Health Partners
EPOIn network
In network only. Out of network visits are not covered.
Cedar Ridge HMO
Cedar Ridge Health Partners
HMOIn network
A referral from your primary care provider is needed for specialists.
Cedar Ridge Medicaid Family
Cedar Ridge Health Partners
Medicaid managed careIn network
Covers children, parents and pregnant patients. Bring your member card.
Children's Health Insurance Program (CHIP)
Children's Health Insurance Program
Government programIn network
Covers checkups, vaccines and sick visits for children.
Colorado River EPO
Colorado River Benefits
EPOIn network
In network only. Out of network visits are not covered.
Colorado River Medicare Advantage
Colorado River Benefits
Medicare AdvantageIn network
All Alder Health services are covered in network.
Colorado River PPO
Colorado River Benefits
PPOIn network
No referral needed to see a specialist.
Hill Country Alliance HMO
Hill Country Health Alliance
HMOIn network
A referral from your primary care provider is needed for specialists.
Hill Country Alliance Medicaid Choice
Hill Country Health Alliance
Medicaid managed careIn network
Covers children and pregnant patients. Bring your member card.
Hill Country Alliance PPO
Hill Country Health Alliance
PPOIn network
No referral needed to see a specialist.
Live Oak HMO
Live Oak Benefits
HMOLimited network
In network at the Mueller clinic only. South Lamar visits are out of network.
Live Oak Medicare Advantage Value
Live Oak Benefits
Medicare AdvantageIn network
All Alder Health services are covered in network.
Live Oak PPO
Live Oak Benefits
PPOIn network
No referral needed to see a specialist.
Lone Star Mutual HMO Select
Lone Star Mutual
HMOIn network
A referral from your primary care provider is needed for specialists.
Lone Star Mutual Medicare Advantage Plus
Lone Star Mutual
Medicare AdvantageIn network
All Alder Health services are covered in network.
Lone Star Mutual PPO Gold
Lone Star Mutual
PPOIn network
No referral needed to see a specialist.
Lone Star Mutual PPO Standard
Lone Star Mutual
PPOIn network
No referral needed to see a specialist.
Medicare Part B, original Medicare
Medicare
Government programIn network
Primary care, women's health and vaccines are covered. Counseling is covered when billed by a licensed counselor.
Mesquite HMO
Mesquite Assurance
HMOIn network
A referral from your primary care provider is needed for specialists.
Mesquite Marketplace Silver
Mesquite Assurance
MarketplaceLimited network
In network for adult primary care and women's health. Pediatrics and counseling need a check first.
Mesquite PPO
Mesquite Assurance
PPOIn network
No referral needed to see a specialist.
Pecan Valley HMO
Pecan Valley Insurance
HMOLimited network
In network for primary care, pediatrics and women's health. Counseling and nutrition are out of network.
Pecan Valley POS
Pecan Valley Insurance
POSIn network
Choose a primary care provider to coordinate your care.
Pecan Valley PPO
Pecan Valley Insurance
PPOIn network
No referral needed to see a specialist.
Prairie Wind POS
Prairie Wind Health
POSIn network
Choose a primary care provider to coordinate your care.
Prairie Wind PPO
Prairie Wind Health
PPOIn network
No referral needed to see a specialist.
Texas Medicaid, fee for service
Texas Medicaid
Government programIn network
Covers children and pregnant patients. Bring your card.
How copays and deductibles work
Four words explain most of a health insurance bill. Your plan card or your insurer’s website shows the amounts that apply to you.
An example
Sam has a $30 copay for primary care and a $1,000 deductible. A checkup costs Sam $30, and the plan pays the rest. A blood test that costs $120 counts toward the deductible, so Sam pays it until the $1,000 is reached.
- Copay
- A fixed amount you pay at the visit, for example $30 for a checkup. Your plan card lists it.
- Deductible
- What you pay in a year before your plan starts to share the cost. Some visits, such as checkups, are covered before you reach it.
- Coinsurance
- A percentage you pay after the deductible. With 20 percent coinsurance, you pay 20 dollars of a 100 dollar service.
- Out-of-pocket maximum
- The most you pay in a year for covered care. After that, your plan pays the rest.
Prices without insurance
If you do not have insurance, these are our self-pay prices. We tell you the price of any test or procedure before we do it, and we offer payment plans on request.
Primary care
| Visit | Price |
|---|---|
| New patient visit | $165 |
| Established patient visit | $115 |
| Annual physical for adults | $185 |
Women's health
| Visit | Price |
|---|---|
| Annual well-woman exam | $195 |
| Problem visit | $140 |
| Birth control visit, device cost extra | $120 |
Prenatal care
| Visit | Price |
|---|---|
| First prenatal visit | $210 |
| Routine prenatal visit | $95 |
| Postpartum visit | $140 |
Pediatrics
| Visit | Price |
|---|---|
| Well-child checkup | $135 |
| Sick visit | $105 |
| School, camp or sports form | $55 |
Nutrition
| Visit | Price |
|---|---|
| First nutrition visit | $125 |
| Follow-up visit | $95 |
| Family session, up to three people | $150 |
Mental health counseling
| Visit | Price |
|---|---|
| Intake session | $150 |
| Follow-up session | $120 |
| Reduced-rate session, income based | $70 |
Vaccinations and travel health
| Visit | Price |
|---|---|
| Vaccine visit, administration fee, vaccine cost extra | $35 |
| Travel health consultation | $140 |
| Immunization record or form | $25 |
Chronic condition management
| Visit | Price |
|---|---|
| Chronic condition visit | $125 |
| Extended planning visit | $165 |
| Phone check-in | $60 |
Prices and plans are invented for this demonstration. Questions about a bill? Call billing on 512 555 0145.
Not sure what your visit will cost?
Call our billing team before you come in. We will check your plan and give you an estimate in plain numbers.