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A State of Texas Resource for Finding Health Insurance Coverage

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Coverage Options for Seniors

TDI Resources

Options

Health care coverage is important for people of all ages, but can be a special concern for seniors facing more frequent and higher cost medical care.

Here are five options for finding health care coverage:

  1. Find group coverage
  2. Determine if you qualify for Medicare
  3. Determine whether you qualify for Medicaid
  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 if you qualify for Medicare    

Medicare is the federal health insurance program for seniors and people with disabilities. You qualify if you are over age 65 and have worked full-time for a total of at least 10 years, or have received Social Security disability income for a total of at least two years. Also, individuals with Lou Gehrig's disease or end stage kidney disease automatically qualify for Medicare.

Medicare typically pays a large portion of participants’ health care costs, but not all of them. For people who want to reduce the uncertainty about the amount they need to budget for health care, Medicare supplement policies help cover out-of-pocket costs that Medicare doesn’t cover. Insurance companies generally must automatically accept you for Medicare supplement coverage if you apply during the six-month open enrollment period beginning on the day you join basic Medicare coverage.

It is important to note that not everyone needs a Medicare supplement policy. There are other health coverages that may also pay for Medicare's out-of-pocket costs, such as group health coverage from an employer or as part of a retirement benefit, a Medicare Advantage plan, Medicaid, or a Medicare savings program.

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

3. Determine whether you qualify for Medicaid    

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.

 

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 market -- 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.

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: