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Shopping for health insurance in the state of Texas might seem like a daunting task. Thankfully, there are many options open to Texans who are uninsured or underinsured. Whether you're healthy or not, this page will provide you with valuable information for obtaining health coverage. Read on to learn about the difference between group and individual coverage. If you're healthy enough to obtain coverage on the individual market or if you have a small business and qualify for small group, Health Plan One can help. If not, review the information on this page about Texas Medicaid, high risk pool, and CHIP. All of these government programs can help those who are medically uninsurable or who cannot afford private insurance to obtain basic health coverage.
What Every Texan Should Know About Health Insurance
The type of health insurance familiar to most consumers is group coverage offered by an employer. With group health insurance through your employer the policy is partially paid for by the company on behalf of their employees. The company will contribute a large percentage toward the monthly premium and you (the employee) will be responsible for paying the difference, about 16-27%. With group plans you have little choice in the specific benefits of the plan (these are determined by negotiations between the company and the insurance carrier) but you also cannot be denied coverage under the group plan no matter what prescriptions you may take or preexisting conditions you may have. By insuring a large group of employees together under one plan of the company's choosing, individual employees are not medically underwritten; rather the entire group is underwritten as a whole to determine the premium level everyone will pay. Therefore, the amount you pay in premiums as well as the quality of the coverage you receive are dependent not on how healthy you are or what benefits you would like to have, but how healthy your group is as a whole and what benefits the company has chosen for you.
Unfortunately, companies frequently have a waiting period before new employees can qualify to receive health insurance benefits. If this is the case with your new job, consider getting a short-term policy from the point where your previous coverage ends to the time when your new company's insurance kicks in. Such options are available through Health Plan One. Simply visit our Short-Term information page for your free quotes.
It is important not to have a lapse in coverage of more than 63 days. If you do, your new insurance carrier may refuse to cover treatment for pre-existing conditions you may have such as asthma or acne for up to a year after your policy goes into effect. For this reason, having continuous health insurance coverage is particularly important.
What If I'm Between Jobs?
As previously mentioned, it is important not to have a break in coverage of more than 63 days. As a result, if you've recently lost your job look into extending the coverage you had with your employer through COBRA. With the COBRA program through the federal government you can extend your plan for up to 18 months after losing your job. You will however have to pick up the entire premium cost which your employer had previously been paying. For this reason, it is frequently more economical for people who've lost their jobs to invest in an individual/family insurance policy through Health Plan One.
With individual coverage, you choose the health insurance carrier and benefits you want with the help of Health Plan One. We will quote plans for you and your family from all the different carriers available in Texas so that you can choose from a wide price range and spectrum of options to tailor a plan that fits your needs. Even if you are not between jobs, a plan on the individual market through Health Plan One could still be the best option for your family. Many companies do not offer benefits to their employees, and often those companies that do offer benefits do so at an exorbitant cost for low quality plans. It is important to note that with individual coverage in Texas each person who applies is medically underwritten and may be approved, denied, or rated-up by the carrier depending on their health history in recent months.
If you're healthy and are unhappy with the health insurance offered by your employer, are between jobs, or are not offered benefits by your company, enter your zip code into the Health Plan One quoting engine at the top of this page to view the most competitively priced plans in your area with benefits tailored to your needs. Quotes are absolutely free, and you're under no obligation to buy. Our licensed insurance specialists are also available via LiveChat (see the button to the right) or toll-free at (877) 567-5267 to answer any questions.
Small Group Plans
If you are self-employed, you can apply for a small group plan. You must have 2 or more eligible employees who each work at least 30 hours per week. Small group plans are medically underwritten by all carriers in Texas. This means that though no one in the group can be denied coverage, the carrier can increase the rates based on the health history of employees enrolling. Health Plan One can help you by quoting plans for small groups. Simply call us toll-free (877) 567-5267.
If you're not healthy there are still many programs available to you. See below for details on the options which best fit your medical and financial situation.
Texas Medicaid and Medicare
Medicaid works in practice much like having regular health insurance; if you qualify you'll receive a Medicaid card which you can show your doctor at an appointment. If your doctor participates in Medicaid, the State will pay the bill for the appointment minus any other health insurance you may have. The program pays for many medical services including acute care services, prescription drugs, and long-term services and supports, depending on need. There are 3 major categories of individuals eligible for Medicaid's full benefits:
- Families and children (based on income level and depending on age or pregnancy)
- Cash assistance recipients (based on whether you receive TANF or SSI)
- Aged and disabled (based on income level, age, and physical/mental disability)
There are 3 other groups eligible for partial Medicaid benefits:
- Medicare beneficiaries (based on income level and age)
- Non-citizens (legal permanent residents and undocumented persons ineligible for Medicaid because of citizenship status can receive emergency services)
- Women (based on income level and age, women ineligible for full benefits may receive women's health services only) â€“ Women eligible for this program are ages 18-44 whose income is up to 185% of the federal poverty level.
Medicaid's Income and Asset Limits: income limits vary depending on the size of your family and where you live. For women who are pregnant and infants, the income limit is 185% of the federal poverty level, a number which is reassessed yearly. Children ages 1-5 qualify if their family's income is up to 133% of the federal poverty level, and children ages 6-18 qualify if their family's income is up to 100% of the federal poverty level. The medically needy qualify if their income is up to $275 per month. Special eligibility requirements apply for those needing long-term care.
In depth information on eligibility requirements is available here: http://www.texashealthoptions.com/cp/disable.html The full Texas Medicaid handbook is available here: http://www.hhsc.state.tx.us/medicaid/reports/PB7/PinkBookTOC.html
Click here for information about Texas Medicare Advantage Plans.
CHIP & Texas Children's Medicaid
The Children's Health Insurance Program (CHIP) covers Texans age 18 or younger who are legal permanent residents or US citizens. The citizenship or immigration status of the parents doesn't affect the child's eligibility and is not asked on the application. CHIP was designed to give children whose family's incomes are high than the qualifications for Children's Medicaid access to health insurance. To see the income guideline chart for Texas CHIP and Children's Medicaid, click http://www.chipmedicaid.org/english/chart_income_guidelines.htm
Children's Medicaid health coverage is provided at no cost to the children of qualifying families. CHIP, as previously stated, is designed to target families who earn too much to qualify for Medicaid, but cannot afford private health insurance. CHIP enrollment fees and co-payments are based on the family's income. However these costs are still very low. Enrollment fees are less than $50 per family for each 12 month term of eligibility and most co-payments for doctor visits and prescription drugs range from $3 to $10. The benefits include regular checkups and office visits, dentist visits (cleanings and fillings), vaccines, mental health care, and eye exams (and glasses). A full list of the benefits available through CHIP and Children's Medicaid is available here: http://www.chipmedicaid.org/english/cover.htm All of the links listed above are also available en EspaÃ±ol here: http://www.chipmedicaid.org/espanol/index.htm
CHIP further offers a program called CHIP Perinatal for Texas residents who are pregnant, uninsured, and unable to get Medicaid. Information on this program is available here: http://www.hhsc.state.tx.us/chip/perinatal/index.htm
Texas Health Insurance Risk Pool
The option of entering the high risk pool is open to those under 65 who are and haven been for the last 30 days legal residents of Texas and a US citizen or permanent resident for at least 3 continuous years. You must also give evidence of one of the following qualifications to enter the pool: http://www.txhealthpool.org/eligibil.html. These qualifications all include rejection by an insurance company for being medically uninsurable and/or having one of a list of qualifying pre-existing conditions. Dependents are also eligible for coverage in the high risk pool. For all relevant information on things that could disqualify you from the pool, as well as information on pre-existing conditions please see http://www.txhealthpool.org/eligibil.html Full information on the benefits available to members of the high risk pool is available on the pool's website at http://www.txhealthpool.org/benefits.html.
Texas also has an entire website devoted to helping those with medically uninsurable conditions and financial difficulties find health insurance here http://www.texashealthoptions.com/cp/disable.html