FirstCare Insurance Review & Complaints: Health Insurance (2023)

FirstCare is a Texas health insurance company offering both individual and group plans. The company offers a wide range of HMO plans, all of which are offered on the health insurance marketplace.

What is there to know about FirstCare?

FirstCare was founded in Amarillo, Texas in 1985. They are owned by Covenant Health and Hendrick Health System and offer a large network of providers and services through these two groups.

FirstCare covers much of Texas but remains a smaller, regional insurer, with about 172,000 members. Their plans include a range of individual and family products on the health insurance marketplace, Medicaid plans, and CHIP options. They also offer group plans through employers.

The company has offices in Amarillo (which is the headquarters), Abilene, and Lubbock. Plans are sold directly as well as through the marketplace website. What you pay will depend on a number of factors, and costs for health insurance can vary. Finding affordable health insurance means checking all the options that a potential company has to offer.

What types of insurance products are offered?

FirstCare offers health insurance plans at the gold, silver, and bronze levels for individuals and families. All of the plans are available through the marketplace.

Bronze Plans

The HMO CMS Standard Bronze plan has deductibles of $6,650 individual and $13,300 family. The first three primary care non-preventative visits have a co-pay of $45 with no deductible. After those three, the deductible applies until it is met, and then the $45 co-pay is re-applied. Specialist visits are covered at 50% after the deductible. This plan has a $0 co-pay for tier 1 prescription drugs with no deductible applied; the deductible does apply to tiers 3-5.

The HMO Bronze HSA Eligible plan has the same deductibles, but coverage is not applied until those deductibles are met. After the deductibles, the coinsurance amount is 0% on most services. This includes prescription drugs, which are covered at 100% after the deductible is met.

Silver Plans

There are two main silver level health plan options, and each plan has four levels of health care coverage depending on where the applicant falls on the income scale. Applicants who qualify for discounts based on the Federal Poverty Level scale can get these plans with lower deductibles and co-pays, as low as $0 deductible and $5 primary care visits. All silver plans have a $0 co-pay for tier 1 drugs.

The HMO Silver 3100 without any income qualifications has a $3,100 individual deductible and a $6,200 family deductible. There is no deductible for prescriptions. The primary care visit co-pay is $25, and specialist visits are $50.

The HMO Silver HSA 100% plan has higher deductibles – unless the applicant meets income qualifications – at $3,750 individual and $7,500 family. The deductible must be met before any coverage is offered, and after it is met all services are covered at 100%.

Gold Plans

There are two gold plan options, one a co-pay and one a coinsurance plan. The plans are similar in many ways, with both having a primary care co-pay of $30 and specialist co-pay of $50.

The HMO Gold Coinsurance plan has an individual deductible of $1,200 and a family deductible of $2,400. The HMO Gold Copay has no deductible. The main difference between these two plans is hospital coverage; one has a coinsurance amount and the other a co-pay for inpatient and outpatient procedures.

State Sponsored Programs

FirstCare offers programs for both STAR, the Texas Medicaid program for low-income families, and CHIP coverage, the Children’s Health Insurance Program. Both of these programs have income requirements.

Does the company offer affordable rates?

FirstCare offers a basic online quoting system, through which we obtained health plan rates for a single 30-year-old in the ZIP code of the company’s headquarters.

The HMO Bronze with HSA was the cheapest plan in our sample, at $160.69 a month. The most expensive is the Gold Copay at $287.44.

While we are unable to compare the rates here to other states, based on what we have seen elsewhere for this type of coverage, FirstCare’s rates are reasonable. They are an HMO, which means lower rates as a general rule in return for a more limited network of providers, however, the coverage options are good, with generally low co-pays and low-deductible options.

How are claims handled?

FirstCare is an HMO with two local health systems providing care. Claims will be processed directly through the providers, which usually means faster claims handling.

Are the ratings and consumer reviews positive?

FirstCare has an A+ rating with the Better Business Bureau (BBB), and currently, there are no customer service complaints on file for the past three years.

Although the company is accredited by the National Committee for Quality Assurance, they are not rated for 2016-2017 due to an insufficient level of information.

There are very few reviews of FirstCare to be found. We found little in the way of complaints or reviews on major websites that normally offer insurance company complaints/reviews. There are three ratings on Yelp, one of which comes from a former employee. The other two cite poor customer service experiences.

Overall, there is not much on which to form a solid opinion of their reputation. Generally when looking at healthcare services, you want to look at customer satisfaction ratings as well as the financial strength rating that they have. This shows you both the quality of service you’ll receive, and if the company is stable.

What’s the bottom line?

FirstCare offers affordable, quality care with HMO health insurance plans in a specific region of Texas. They have a low complaint volume and nothing that raises any red flags in the complaints. They are likely to appeal to those who do not mind a limited provider network and are looking for uncomplicated insurance options.