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Public Assistance

Health insurance in Texas continues to become more and more expensive. The average annual premium for a 30 year old male is $2,000 per year and higher for females. To insure a family in Texas will usually cost over $5k per year.

Besides the cost factor is the underwriting factor. Texas is not a guarantee issue state and therefore for some people, health insurance is out of reach even if they have the money to afford it.

So what are your options?

Texas High Risk Pool or PCIP

For the medically challenged there is the new federal PCIP program. Also known as the Texas Pre-Existing Condition Insurance Plan, this plan is for eligible residents of Texas who are legal citizens and have been without health coverage for six continuous months due to a uninsurable health condition. The program is run by the U.S. Department of Health and Human Services not the state of Texas. The plan covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a preexisting condition.

Texas PCIP 2012 Benefit Summary

In addition to your monthly premium, you will pay other costs. In 2012, you will pay a $1,000 to $3,000 deductible, which varies by your plan option, for covered medical benefits (except for preventive services) before the plan starts to pay. A plan option may have a separate drug deductible. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $40 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your combined out-of-pocket costs for in-network and out-of-network covered services cannot be more than $7,000 per year. The maximum is even less if you use only in-network providers.

Texas PCIP Enrollment Form

Medicaid and Other Programs

Texas has its boots on nice and tight as they make it simple to get assistance for many programs at once. At the website below you can apply for SNAP food benefits (food stamps), Health care benefits (Medicaid), Cash help for families (TANF), Medicare savings programs, or Long-term care all in the same place.

Childrens Medicaid or CHIP

Children in Texas without health insurance may be able to get low cost or free health coverage from the Children’s Health Insurance Program (CHIP) or Children’s Medicaid. Both programs cover office visits, prescription drugs, dental care, eye exams, glasses, and much more.

Families with children who get Children’s Medicaid pay nothing and children with CHIP pay no more than $50 a year for health care coverage. Some families with CHIP also may need to pay co-pays for some services.

What Does It Cover?

CHIP and Children’s Medicaid both offer many benefits:

  • Dentist visits, cleanings, and fillings
  • Eye exams and glasses
  • Choice of doctors, regular checkups, and office visits
  • Prescription drugs and vaccines
  • Access to medical specialists and mental health care
  • Hospital care and services
  • Medical supplies, X-rays, and lab tests
  • Treatment of special health needs
  • Treatment of pre-existing condition

Apply for CHIP at

CHIP Coverage for Unborn Children

If you are pregnant, a Texas resident, you don’t have insurance, and you cannot get Medicaid, you may be able to get perinatal coverage from CHIP. This coverage is for your unborn baby. It covers your labor with delivery and your baby’s health and medical services for its first months of life.

CHIP perinatal benefits include:

Up to 20 prenatal visits
Prescription drug coverage
The cost of giving birth*
Two doctor visits for mom after the birth of the baby
Regular checkups, vaccines, and prescriptions for your baby

* Hospital and other costs related to labor with delivery of the baby. Costs from labor that does not result in a birth and false labor are not covered.

Medicaid for Pregnant Women

A pregnant woman can receive Medicaid benefits during pregnancy and up to two months after birth if she meets certain income requirements. To learn more, visit the HHSC website.

The Texas Consumer Health Assistance Program (CHAP)

Texas CHAP helps people without health coverage at a time when they need it most. It’s operated by the Texas Department of Insurance (TDI).
Texas CHAP can help you:

Learn about your rights under federal and state law
Enroll in a health plan, including the Pre-Existing Condition Insurance Plan (PCIP)
Appeal a health plan’s denial of a treatment or service
Resolve a complaint against your health plan or insurer
Obtain the health care premium tax credit (for small businesses)

The Pre-Existing Condition Insurance Plan (PCIP) may be right for you if you:

Have been uninsured for at least six months
Have a pre-existing condition
Are a U.S. citizen or residing legally in the United States

Please call 1-855-TEX-CHAP now for more information about these and any other insurance questions and concerns.