Texas Health Insurance

They say that "everything's bigger in Texas." Unfortunately, the saying holds true for the problems with health insurance in the state. Newsweek magazine recently ranked Texas one of the lowest in the nation based on the access, quality, equity, and costs of medical coverage. Don't let this worry you too much, however. It is possible to get good health insurance in Texas, as long as you do your homework (read our guide below!) and compare quotes from several different carriers to get the coverage that's right for you.

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Texas Individual Health Plans (TX)

If you're looking to purchase a health plan for yourself, the basic choice you will need to make is between a group or individual plan. The first includes group networks such as HMOs, PPOs, POSs, and HSAs. Costs are spread out among members, so your rates will be lower. But if you want a more customized policy, take out a more costly individual plan. Also, Texas law forces individual carriers to offer low-cost Consumer Choice Benefit Plan.

If you have a health problem, insurance carriers are allowed to turn you down for coverage. And unless you are purchasing an HMO policy, you can be given an exclusion period and elimination riders for your preexisting condition.

Texas Family Medical Coverage

Health insurance is essential, especially if you have a family. The good news is that in Texas, group health insurers must cover you if you are qualified, even if any family members have health problems. Also, if you work for a small business and have coverage under the company's plan, your company is also required to cover your family.

If your policy covers dependents, and if you have a grandchild, a newborn, an adopted child, or a disabled child, he or she could be eligible for special considerations for insurance. Similarly, going through a divorce, getting married, or losing your job may make you eligible for special opportunities to receive group coverage.

Texas health carriers are allowed to check the past six months of your family's medical history, and impose exclusion periods (max. 12 months) if preexisting conditions are found. The exception to this is HMOs, who cannot give you an exclusion period.

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Texas Health Insurance Laws Concerning Preexisting Conditions

Under Texas law, private insurance companies are free to refuse an applicant based on general health status, specific preexisting conditions and other factors. State law also allows the insurance company to utilize a five-year look back period, to figure out the time in which the preexisting condition was diagnosed or treated. Pregnancy can be considered a preexisting condition in Texas, although genetic information cannot be used in determining a condition.

HMO vs. non-HMO Policies— If you purchase a health insurance policy from an HMO in Texas, you will not be subjected to a preexisting condition exclusion period. However, if you buy a non-HMO policy, there are different ways insurance companies are allowed at the time you purchase the policy, to exclude preexisting condition coverage. The company could use up to a 24-month preexisting condition exclusion period or it could impose an elimination rider, which would exclude coverage for a preexisting condition.

Texas Health Insurance Risk Pool— If you are refused coverage, or given a limited policy, you could qualify for coverage from the Texas Health Insurance Risk Pool. There are also public health services and statewide tax assistance. While most of the organizations are for high-risk, low-income applicants, it could provide an additional avenue for your needs.

Need a New Health Plan in Texas? (TX)

If you're moving to Texas, leaving your job, or just thinking about changing health carriers or plans, here's what you need to know about getting a new health policy:

• State continuation coverage — Also known as COBRA. This allows you to keep the plan you had under your previous employer (although some of the benefits will not be exactly the same).
• Waiting period — Texas laws allow employers to delay the start of employee benefits.
• Non-federal employers — These may include city and municipal governments, which could follow different rules than other companies in the state. Check with your employer or the Texas Dept. of Insurance for more information.
• Employee health plans — Employers in TX do not have to provide health insurance for their employees.

Looking for a health plan in Texas? Get a free health quote!

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