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Texas Health Insurance

If you're looking for Texas health insurance quotes you've come to the right place. Compare quotes instantly from the leading carriers in the state of Texas and see how you can save on top-rated coverage. Enter your Texas zipcode above to get started or browse below for more information about Texas health insurance plans in your community.
44th Place in State Health Report Card

State Health Report Card

Smoking went down from 21.9 percent to 15.8 percent among adults in the last ten years. There are nearly 2.9 million adult smokers in Texas. Obesity went up from 23.1 percent to 31.7 percent among adults in the last ten years. There are about 5.8 million obese adults in the state. Diabetes went down from 6.2 percent to 9.7 percent among adults in the last ten years. There are about 1.8 million adults with diabetes in Texas. Children living in poverty increased from 22.0 percent to 26.5 percent among those under 18 years old in the past five years. The rate of preventable hospitalizations went down from 78.7 to 72.8 discharges per 1,000 Medicare enrollees in the past year.

Texas Health Insurance Laws and Regulations

Texas health insurance plans are required to be sold with a guaranteed renewability clause. This will allow all policyholders to renew their health coverage at their own discretion, as long as they keep up with their premium payments. Health insurers are also prohibited from canceling coverage based on the deteriorating health of a client. When writing new Texas health insurance plans, insurers can exclude coverage for a pre-existing condition for up to two years. The exclusion period spent on one plan shall be credited toward the next as long as continuous coverage was maintained. However, insurers can permanently exclude a pre-existing condition through an "exclusion rider." Health insurers in Texas are allowed to deny an application based on age, family history, location, and other risk factors. The cost of health insurance can also be determined using such factors. Small businesses, with two to fifty employees, can access group health policies available to other small businesses in the state. Certain conditions may be required in order to maintain group health policies such as a minimum percentage of employee participation or a minimum contribution by the employer. Texas health insurance quotes for group coverage can vary according to the risk factors of its members. However, small group health plans cannot be cancelled due to a member's health condition. Self-employed individuals in Texas are not eligible for group health insurance unless they have at least one other employee. However, they can opt for an individual health coverage, which has the advantage of having a portion of the premium payments tax-deductible.   

State Government Insurance Programs Offered

Texas Health Insurance Pool (The Pool)

888-398-3927 TDD 800-735-2989

Texas Health Insurance Pool (The Pool) offers health coverage to qualified Texas residents who cannot acquire health insurance from commercial providers due to an existing medical condition. Benefits covered include physician visits, hospital services, prescription drugs, therapy (physical, speech, and occupational), mental health, and many more. Eligibility: 1. Must be a U.S. citizen and resident of Texas. 2. Must have a qualified pre-existing condition. 3. Must be ineligible for public or employer-based coverage. 4. Must have maintained continuous coverage for at least 18 months with the last day in a group health plan.

Texas employee Group Insurance Program (GBP)

877-275-4377 512-867-7711 (Austin)

Texas Employee Group Insurance Program (GBP) is an insurance program administered by the Employees Retirement System of Texas (ERS). It offers comprehensive coverage to retirees, employees, elected officials, higher education employees, their dependents, and certain other groups. Two types of comprehensive health plans are available: HealthSelect and HMOs. Benefits include physician services, prescription services, inpatient and outpatient hospital services, and many more. There is a 90-day waiting period before coverage begins. Eligibility: In order to qualify for the program, one must be an employee of the following: a state agency, an institution of higher education (excluding the University of Texas and Texas A&M University), Windham School District, Texas Municipal Retirement System (TMRS), Texas County and District Retirement System (TCDRS), and Community Supervision and Corrections Department (CSCD).

Children’s Health Insurance Program (CHIP) www.chipmedicaid.org

800-647-6558 877-543-7669 (Texas only)

Children's Health Insurance Plan (CHIP) in Texas offers quality health care to families whose household income disqualifies them from Medicaid coverage, but cannot afford to purchase a private health insurance for their children. Plan benefits include specialists visits, hospital care, lab tests and X-rays, prescription drugs, well checkups and immunizations, and eye exams and glasses. Eligibility: 1. Must be a U.S. citizen or qualified residents living in Texas. 2. Must be under 19 years of age. 3. Must not have any health insurance coverage for at least six months prior to application. 4. Must have household income between 101% and 200% of the FPL.

Medicaid

In Texas: 2-1-1 877-541-7905 800-252-8263

Medicaid pays for acute health care (physician, inpatient, outpatient, pharmacy, lab, and x-ray services), and long-term services and supports for aged and disabled clients

Medicare

800-633-4227 www.medicare.gov

Medicare is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.

Children with Special Health Care Needs (CSHCN)

800-252-8023

Ambulances, Ambulatory surgery, Primary and preventive care, Inpatient rehabilitation and outpatient care, Speech and hearing services, Vision and dental care, Family support and mental health, Laboratory and radiology, Equipment and medical supplies, Home health nursing, Hospice and hospital care, Meals, Lodging, Medical transportation and medicines, Occupational and physical therapy, Orthotics and prosthetics, Special nutritional products, Insurance premium payment assistance, and Case management. Must be a Texas resident and either be: A) Younger than 21 years old with a chronic physical or developmental condition that will last for at least 12 months; that if not treated may result in disability; that requires health and related services beyond those required by children generally; and the condition must show physically (body, bodily tissue or organ). Condition must not be only a delay in intellectual development or solely a mental, behavioral, or emotional condition. Or B) A person of any age with cystic fibrosis. Enrollees must keep private health insurance, Medicaid, CHIP, or SKIP coverage all times. CSHCN is the payer of last resort. It will pay only after private or public insurance has been billed.

Indian Health Services (IHS)

Albuquerque Office 505-248-4500 www.ihs.gov (Search: Albuquerque) Oklahoma City Office 405-951-3820 www.ihs.gov/oklahoma

Must exhaust all private, state, and other federal programs. Must be regarded by the local community as an Indian; is a member of an Indian or Group under Federal supervision; resides on tax-exempt land or owns restricted property; actively participates in tribal affairs; any other reasonable factor indicative of Indian descent; is a non-Indian woman pregnant with an eligible Indian’s child for the duration of her pregnancy through post-partum (usually 6 weeks); is a non-Indian member of an eligible Indian’s household and the medical officer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.

Heath Care Reform

With the new health care law, children under the age of 26 can choose to stay under their parent's Texas health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In Texas, 300,731 young adults have insurance coverage through this provision as of June 2011.

The new health care law allowed 221,395 Medicare policyholders in Texas to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 210,763 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $639 per person or a total of $134,754,191 was saved in Texas.

Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 4,029 individuals in Texas have benefited from this new law.

When looking at Texas health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. Around 5,003,000 private policyholders in Texas will get greater value for their premium payments because of this 80/20 rule.

Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all Texas health insurance with no deductibles or co-pays. In 2011, 2,208,969 Medicare subscribers and 3,836,000 individuals with private policies received such services in Texas.

Under the new law, insurance companies are no longer allowed to impose an annual dollar limit - a cap on the yearly spending for your benefits, or a lifetime dollar limit - a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 7,536,000 Texas residents have benefited from this law.

If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of Texas received a total of $1 million.

All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In Texas, 379 community health centers received a total of $95.8 million to fund these improvements.

In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. Texas has already received a total of $38 million to support its policies, programs, and communities to help its residents lead healthier lives.