Navigating Public Health Insurance in Texas

Are you a Texas resident unsure about your public health insurance options? You’re not alone. Millions rely on Medicaid and Medicare for coverage, and the process can seem complicated. This guide simplifies enrollment and eligibility for these programs in 2024.

Understanding Medicaid and Medicare

• Both are entitlement programs: Anyone meeting the criteria qualifies for coverage.
• Medicaid: Targets low-income families, children, people with disabilities, and some seniors. Funded jointly by federal and state governments, with each state managing its program.
• Medicare: Federal program for people 65+ or those under 65 with certain disabilities. Offers two options:
  • Original Medicare (Parts A & B): Covers hospitalization, doctor visits, and some home health care.
  • Medicare Advantage (Part C): Offered by private companies, includes Parts A & B and often additional benefits.

Checking Your Eligibility

• Medicaid: Must be a Texas resident, meet income requirements, and fall into specific categories (pregnant, disabled, etc.).
  • Open enrollment ended in January, but exceptions exist for those with recent life changes or income fluctuations.
  • Use the federal eligibility tool: federal eligibility tool: https://www.benefits.gov/
  • Special enrollment period for those recently disenrolled from Medicaid (until July 31, 2024): Apply through the Health Insurance Marketplace: Health Insurance Marketplace: https://www.healthcare.gov/
  • Texas moms with recent pregnancies gained extended coverage (as of March 1, 2024).
• Medicare: Must be a U.S. citizen/permanent resident, 65 or older with at least five years of U.S. residency, and have paid Medicare taxes for ten years. Spouses of beneficiaries may also qualify. People with disabilities and Social Security Disability Insurance (SSDI) may qualify before 65.

Enrolling for Benefits

• Medicaid & CHIP:
  • Apply online: Texas Benefits website: https://www.yourtexasbenefits.com/
  • Request a paper application by mail or download one from the website. Submit by mail to your nearest Texas Health and Human Services office. (Locate one here: Texas Health and Human Services office.)
  • Call 2-1-1 (Monday-Friday, 8 AM to 6 PM CT)
• Medicare: Enroll through the Social Security Administration: Medicare applications: [invalid URL removed]
  • You may also qualify for Medicaid to help with costs: Texas dual eligibility information: [invalid URL removed]

Alternatives if Ineligible

• Consider subsidized plans through the Affordable Care Act (ACA) Marketplace if you don’t qualify for Medicaid or Medicare. Legal status is required, but U.S. citizenship is not.
  • Estimate your subsidy with HealthInsurance.org’s tool: [invalid URL removed]
  • Qualifying life events may allow applications outside the open enrollment period: qualifying life events for ACA marketplace.
  • Apply for a subsidized plan here: ACA marketplace application: https://www.healthcare.gov/

Getting Help

• Medicaid & CHIP: Contact your health plan provider first (phone number on your ID card). If you don’t have a plan, call the Medicaid Helpline: 800-335-8957.
• Medicare: Call the Texas Medicare Hotline: 800-252-9240.
• Texas Health Information, Counseling and Advocacy Program: Provides assistance with both programs. Find a local office and healthcare providers: Texas Health Information, Counseling and Advocacy Program: https://www.tlsc.org/hicap#

Posted By: HTXNEWS

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