Different Medicaid Plans In Texas


What Type Of Coverage Do You Get If You Are Dual Eligible For Medicare And Medicaid

Court blocks vaccine mandate for employees of Medicaid, Medicare providers in Texas

There are two levels of coverage for beneficiaries who are dual eligible:

  • Full dual eligibleFull dual eligible refers to those who receive full Medicaid benefits and are also enrolled in Medicare. People who are full dual eligible typically receive Supplemental Security Income benefits, which provide cash assistance for basic food and housing needs. Qualifying as full dual eligible is based on your assets, which include checking and savings accounts, stocks, real estate and vehicles .
  • Partial dual eligiblePartial dual eligibility includes those who receive assistance from Medicaid in order to help pay for Medicare costs such as premiums, coinsurance or deductibles. Partial dual eligibles fall into one of four categories of eligibility for Medicare Savings Programs.

A Medicare Savings Program is a federally funded program administered within each state that helps lower income people pay for Medicare premiums, deductibles, copayments and coinsurance.

The four Medicare Savings Programs are outlined below.

Unitedhealthcare Individual And Family Marketplace Plans In Texas

Looking for health care plans on the Marketplace? UnitedHealthcare Individual and Family Marketplace plans offer affordable, reliable coverage options from UnitedHealthcare of Texas, Inc. As part of the American Rescue Plan Act , many individuals and families are now eligible for lower or in some cases $01,2 monthly premiums for Marketplace health coverage.

Call / TTY 711 to talk to a representative.

The Texas Medicaid Wellness Program

The Texas Medicaid Wellness Program is exclusively for those who have Medicaid and suffer from long-lasting and serious health conditions. In most cases, if you are eligible for the Texas Medicaid Wellness Program, you will receive a letter and phone call notifying you of your eligibility. Some people within the Texas Medicaid Wellness Program can join Weight Watchers for free. Everyone in the program has access to special nurses who can help with care management, learning about health conditions and medications, and selecting the best medical care. These nurses are available at any time at 1-800-777-1178 .

Read Also: Rehab Centers In Florida That Accept Medicaid

How Do I Enroll In Medicaid In Texas

If you believe you may be eligible to enroll in Medicaid in Texas:

  • You can enroll through HealthCare.gov, either online or by phone at 1-800-318-2596.
  • You can enroll through the Medicaid website maintained by the Texas Health and Human Services Commission.
  • You can also download and print a paper application, or request that one be mailed to you, by using this page on the Texas Medicaid website.

Tips For Enrolling In Medicare In Texas


If youre shopping for a Texas Medicare Advantage plan, be aware that not all plans are the same. They vary in plan design, provider network, cost structure, and more.

You may want to consider the following when weighing your options:

  • Which plan design works best for you? Do you prefer an HMO in which a primary care doctor oversees you care and refers you to specialists as needed? Or would you rather the flexibility of a PPO that would allow you to see any specialist in your network at your choosing?
  • What is the provider network like? Texas is a big state. You want to be sure to choose one of the Medicare plans in Texas with a network that makes geographic sense for your lifestyle. If you travel, be sure to ask about coverage outside of the state as well.
  • What will you have to spend? Look beyond just monthly premiums. Find out what you can expect to spend when you see a doctor or fill a prescription. Sometimes it ends up being cheaper overall to pay a higher premium for lower out-of-pocket costs at the point of care.
  • What extras are offered? Gym memberships and fitness programs arent just perks they can save you money if you might otherwise pay for them yourself. And if you have a chronic condition, you might benefit from a plan that offers a health management or health coaching program dedicated to helping members manage that condition.

Also Check: First Choice Medicaid Prior Authorization Form

State Of Texas Access Reform Managed Care Program

Community provides both Childrens Medicaid and Medicaid for Pregnant Women. These programs are at no cost to U.S. residents who cannot afford health insurance.

Childrens Medicaid Childrens Medicaid covers a child up through the month of his or her 21st birthday. Income determines eligibility. That income level is different based on age and Medicaid program. Members must recertify every year.

Medicaid for Pregnant Women Medicaid for Pregnant Women covers a childbearing woman of any age. Members must be at 185% or lower of the Federal Poverty Level . Members must recertify every year.

How Can I Find Out What Medicaid Program Im In

You can find out your plan or program either by phone or on the web.


  • 1-800-252-8263

After you pick either English or Spanish, pick option 2 Learn more about the Your Texas Benefits Medicaid card and Medicaid benefits.

Go to www.YourTexasBenefits.com. Follow these steps:

  • From the home page click View my case.
  • Follow the steps for setting up an account or logging in.
  • Once youve logged in, click the Medicaid tab in the upper right part of the screen.

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Health Insurance Coverage For Multiple Years

TriTerm Medical Insurance,4 underwritten by Golden Rule Insurance Company, is short term health insurance that offers coverage for preventive care, doctor office visits, and prescriptions.

  • Apply once for insurance coverage terms that equal one day less than 3 years.
  • $2 million lifetime maximum benefit per covered person on most plans.
  • Eligible expenses for preexisting conditions are covered after 12 months on the plan.

Questions about Short Term or TriTerm Medical insurance? Call / TTY 711 to talk to a representative.

Texas Medicaid Enrollment Numbers

Texas removes Planned Parenthood from Medicaid program

If Texas were to expand Medicaid, its estimated that 1.7 million currently uninsured people would be newly eligible for coverage. Of those people, 771,000 are currently in the coverage gap and have no realistic access to health insurance at all. They dont qualify for Medicaid, but their incomes are under the poverty level which means they are not eligible for subsidies in the exchange.

But despite the fact that the state has opted against using federal funds to expand Texas Medicaid, enrollment in Texas Medicaid/CHIP has grown by 27% more than 1.1 million people since 2013.

Much of that growth is due to the COVID pandemic and the Families First Coronavirus Response Act. That legislation, enacted in March 2020, provides states with additional federal funding but on the condition that nobody be disenrolled from Medicaid until after the COVID public health emergency ends. The PHE has been extended through mid-October 2022, and could be extended again if the COVID situation warrants it.

Once the PHE ends, millions of Americans will have their Medicaid eligibility redetermined and some will lose their coverage as a result.

Prior to 2014, Texas had the highest uninsured rate in the country, and that is still the case. According to U.S. Census data, 22.1% of Texas residents were uninsured in 2013. It stood at 18.4% in 2019, which was still the nations highest uninsured rate.

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We Provide Texas Healthcare Programs That Empower You Your Family And Your Community

Superior HealthPlan has a commitment to improving the health of the community one individual at a time through affordable and reliable healthcare plans. We have an approach to healthcare in Texas that can meet the needs of each person we serve.

Superior HealthPlan is a managed healthcare company that provides healthcare to 1.7 million Texas residents. We began in El Paso in 1999 today, Superior has 8 office locations and serves members in all 254 counties across the state.

Superior works with the State of Texas Health and Human Services to bring you STAR , Childrens Health Insurance Program , CHIP Perinatal Care and STAR+PLUS and STAR Health. We have been the exclusive provider of STAR Health since 2008.

Since 2015, Superior HealthPlan has received a score of 3.5 or higher on a 5.0 scale on the National Committee for Quality Assurance Medicaid Health Insurance Plan Ratings. This includes a score of 3.5 for 2021.

When Can I Enroll In Medicare Texas Plans

While coverage isnt available until your 65th birthday, you can begin the application and enrollment process a few months before your birthday. Your Texas Medicare initial enrollment period begins 3 months before you turn 65 and continues for 3 months after.

If you choose not to enroll during this time, such as if you are still full-time employed and prefer to stay enrolled in your employer-sponsored group plan, you may qualify for a special enrollment period later if your coverage status changes.

Theres also an open enrollment period specifically for Medicare Advantage plans every year from January 1 through March 31. During this time, you can sign up for Medicare Advantage for the first time or switch Medicare plans in Texas.

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Ambetter From Superior Healthplan

The Health Insurance Marketplace is an online shopping mall of healthcare plans. Ambetter from Superior HealthPlan offers affordable healthcare coverage for individuals and families. Depending on your family size and income, you may even qualify for help to pay your monthly premium.

Learn how we transform the health of the community, one person at a time, by visiting our Members First webpage now.

Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives. The Company takes a local approach with local brands and local teams to provide fully integrated, high-quality, and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Centene offers affordable and high-quality products to nearly 1 in 15 individuals across the nation, including Medicaid and Medicare members as well as individuals and families served by the Health Insurance Marketplace, the TRICARE program, and individuals in correctional facilities. The Company also provides a variety of specialty services focused on treating the whole person. Centene focuses on long-term growth and value creation as well as the development of its people, systems, and capabilities so that it can better serve its members, providers, local communities, and government partners.

Unitedhealthcare Connected General Benefit Disclaimer


This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

Recommended Reading: What Is Traditional Medicaid For Adults

State Plan And Amendments

The state plan is the officially recognized document describing the nature and scope of the State of Texas Medicaid program. As required under Section 1902 of the Social Security Act, the plan was developed by the state and approved by the U.S. Department of Health and Human Services. Essentially, the plan is the state’s agreement that it will conform to the requirements of the Social Security Act and the official issuances of the U.S. Department of Health and Human Services.

Plan changes are submitted by the state to the U.S. Department of Health and Human Services as state plan amendments. Through the Centers for Medicare and Medicaid Services, HHS reviews each SPA to determine whether it meets federal requirements and policies. The plan is updated when CMS issues final approval of a SPA.

The plan on this website is for informational purposes only and is not legally binding. The official plan is maintained by CMS Region 6.

Once the plan file is opened, specific sections of the plan are accessible in one of two ways:

  • Use the search function to find information within the plan by key words or phrases. Please remember that since the documents are PDF, the search function is not 100 percent accurate in all circumstances.
  • Approved state plan amendments will be posted as updates are made to the plan.

    Persons with disabilities having problems accessing PDF files may email for assistance.

    This plan is current as of .

    Medicare Dual Eligible Special Needs Plans

    Another type of coverage that may be available to dual eligible beneficiaries is a Medicare Dual Eligible Special Needs Plan .

    A Medicare special needs plan is a certain type of Medicare Advantage plan that is designed for people with specific health conditions or circumstances.

    A D-SNP is built for the specific needs of dual eligibles. All Medicare SNPs provide prescription drug coverage.

    Recommended Reading: How To Qualify For Medicaid In Ohio

    Unitedhealthcare Senior Care Options Plan

    UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

    Dual Eligible Medicare And Medicaid Plans In Texas

    The Benefits of PEMS

    Did you know that you can be eligible for both Medicare and Medicaid? If you meet the income limits for TX Medicaid eligibility but are also over the age of 65 , you can be eligible for both Medicaid and Texas Medicare.

    At Medicare Plan Finder, we have licensed agents all throughout the state of Texas that can help you figure out what benefits you are eligible for and what health plans work best for you. Medicare is confusing, but we can help! or give us a call at 833-438-3676.

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    What Is Medicaid Program

    Medicaid is a joint federal and state program that provides free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities. The federal government provides a portion of the funding for Medicaid and sets guidelines for the program. Medicaid programs vary from state to state. They may also have different names, like Medical Assistance or Medi-Cal.

    Medicaid is the state and federal cooperative venture that provides medical coverage to eligible needy persons. The purpose of Medicaid in Texas is to improve the health of people in Texas who might otherwise go without medical care for themselves and their children.The mission of the program is to improve the health of Texans by:

    • Emphasizing prevention.

    Social Determinants Of Health

    Up to 80 to 90 percent of a person’s health is tied to factors other than clinical care.2 Our person-centered model of care prioritizes these underlying drivers of health, known as the social determinants of health, when evaluating our members well-being.

  • Findings from The Facts Hurt: A State-by-State Injury Prevention Policy Report Trust for Americas Health and Robert Wood Johnson Foundation at http://healthyamericans.org/reports/injuryprevention15/ and from CDC Injury Prevention & Control: Opioid Overdose at www.cdc.gov/drugoverdose/
  • Magnan, S. “Social Determinants of Health 101 for Health Care: Five Plus Five.” NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. 2017. https://doi.org/10.31478/201710c
  • Also Check: Florida Medicaid Change Plan Phone Number

    Qualified Disabled Working Individual Program

    The QDWI Program helps pay for the Medicare Part A premium for certain people who meet one of the following criteria:

    • Have a disability but are still working
    • Lost their premium-free Part A coverage when they returned to work
    • Are not receiving medical assistance from their state
    • Meet the income and resource limits below
    • Income of no more than $4,379 per month for an individual in 2021, or $5,892 for a married couple.
    • Resources of $4,000 for an individual in 2021, or $6,000 for a married couple.

    The income and resource limits listed above may increase in 2022. If your income and resources are slightly higher, you should still apply.

    Texas Has Not Accepted Federal Medicaid Expansion

    • 5,355,045 Number of Texans covered by Medicaid/CHIP as of March 2022
    • 1,748,000 Number of additional Texas residents who would be covered if the state accepted expansion
    • 771,000 Number of people who have NO realistic access to health insurance without Medicaid expansion
    • $6 billion Federal money Texas is leaving on the table in 2022 by not expanding Medicaid

    Read Also: Arkansas Long Term Care Medicaid Application

    Hospital & Doctor Insurance

    Health ProtectorGuard fixed indemnity insurance,5 underwritten by Golden Rule Insurance Company, can supplement your major medical plan by paying cash for eligible, covered medical services, like a doctor visit, a trip to urgent care or a surgical procedure.

    • No deductibles or copays to pay first
    • Benefits paid regardless of other insurance
    • Money to pay costs not covered by major medical plans, like a deductible


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