SKIP TO CONTENT
  • Increase text sizeIncrease text size
  • Decrease text sizeDecrease text size
  • E-mail this page
  • Print this page

A State of Texas Resource for Finding Health Insurance Coverage

Search

Coverage Options for Individuals

TDI Resources

Options

Getting sick can be expensive, especially if the illness is serious. Even minor illnesses and injuries can cost thousands of dollars to diagnose and treat. Health care coverage helps you get the care you need and protects your family from financial losses if someone becomes sick or is injured.

The federal health reform law passed in 2010 expands consumers’ ability to purchase private health insurance, even for people with preexisting conditions. However, the law doesn’t allow you to wait until you get sick to purchase coverage. Coverage through the individual market is generally available only during the annual enrollment period. In 2014, if you don’t have qualifying health insurance, you may owe a penalty when you pay your taxes.

Here are four options for finding health care coverage:

  1. Find group coverage
  2. Determine whether you qualify for Medicaid or Medicare
  3. Apply for coverage through the Texas Health Insurance Pool
  4. Buy an individual policy

1. Find group coverage    

Many employers offer group health coverage as part of their employee benefits packages. Most employers that offer a health plan also provide coverage to their employees' spouses and dependent children.

Your employers must give you at least 31 days from your start date to enroll in a health plan. After this time, you may be required to wait up to one year for the next open enrollment period to join. Insurance companies must offer a 31-day open enrollment period annually.

After you enroll in a health plan, your employer may have a 90-day waiting period before you are eligible to use your benefits.  The company may not charge you or your employer a premium during this period.

If you’re recently unemployed and you participated in your employer's health plan, you may have the right to continue coverage for yourself and your family under the federal law called COBRA and certain Texas statutes.

If employer-sponsored group coverage isn't an option, you may be able to find other group coverage. Trade unions, religious institutions, professional associations, and fraternal organizations sometimes offer health coverage as a membership benefit.

Read Your Health Care Coverage for more information about group plans and COBRA.

2. Determine whether you qualify for Medicaid or Medicare   

Medicaid is a state/federal health insurance program for parents, children, pregnant women, older adults, and people with disabilities with low income. The Health and Human Services Commission (HHSC) determines Medicaid eligibility in Texas. People who receive Temporary Assistance for Needy Families (TANF) automatically qualify for Medicaid.

Medicaid has a buy-in program for employed people of any age with disabilities. The program allows Texans with disabilities to keep their Medicaid benefits, even if they earn more than the traditional Medicaid income eligibility limits.

Call 2-1-1 or visit www.211texas.org/211/ for information about qualifying for Medicaid.

Medicare is a federal health insurance program for people 65 or older, some people under 65 with certain disabilities, and people with end-stage renal disease or Lou Gehrig's disease. If you are on Medicare, it will pay for much – but not all – of your health care needs. Medicare eligibility is determined by the Social Security Administration.

For more information about Medicare eligibility requirements, contact Medicare at 1-800-Medicare (1-800-633-4227) or online at www.medicare.gov.

3. Apply for coverage through the Texas Health Insurance Pool    

The health pool is a program for Texans who can’t get insurance from licensed private insurers because of their health condition. Benefits cover hospital stays, doctor visits, and prescription drugs.

Coverage through the Health Pool may be expensive and premiums are twice the rate charged in the standard market.

The health pool will stop offering coverage on March 31, 2014.

4. Buy an individual policy    

Another option is to buy an individual health plan through the health insurance marketplace or through traditional methods.

You can find coverage through the online insurance marketplace (www.HealthCare.gov), which the federal government operates. The insurance marketplace will begin open enrollment periods for individual and small employer coverage in October, and coverage will begin January 1, 2014.

Insurance companies won’t be able to deny you coverage because of health factors, including a preexisting condition or disability. When deciding what to charge you after January 1, 2014, companies may only consider your age, where you live, whether you use tobacco, and whether the coverage you are buying is for an individual or a family. They also won’t be able place annual dollar limits on essential benefits included in your coverage.

Companies will have to sell a plan to anyone who applies during the enrollment period. The enrollment period – for buying plans inside and outside the marketplace -- runs from October 1, 2013 through March 31, 2014.

Note: If you don’t purchase a plan during open enrollment you may not be able to access coverage until the next annual enrollment period, which will run from November 15, 2014 to February 15, 2015.

People with incomes between 100 and 400 percent of the federal poverty level may be eligible for premium and cost sharing subsidies if they buy their insurance through the insurance marketplace.

View a list of carriers offering individual plans or search for an individual health plan on TDI's website. To verify an agent and company's licensing status, use the Agent Look-Up feature or view the company profiles on our website.

For more information about federal health care reform or to use the insurance marketplace, visit www.HealthCare.gov or call 1-800-318-2596 (24 hours a day, seven days a week).


For more information contact: