Health Insurance for Texas: Who Will Get Help In September?

For 20 years, people in Texas have had less access to medical care. A higher percentage of residents have had to survive without health insurance in Texas than in any other state. Health care reform starts to change that in September 2010.

Over the last five years, Texas health insurance premiums rose by a whopping 40 percent. That was 10 times faster than household income rose for Texas residents during the same period. With the cost of health insurance soaring beyond reach for many working people, families were hit hard. Of the uninsured in Texas, more than 80 percent are in families supported by at least one working member. Although three-fourths of them have incomes above 200 percent of the federal poverty level, health insurance has remained out of reach.

As one in four Texas residents (nearly six million people) were trying to stay healthy in the absence of any kind of health insurance, President Obama signed the Patient Protection and Affordable Care Act into law in March 2010.

How Will Health Insurance In Texas Change In September?

Both young and old will benefit from the Affordable Care Act. This law includes provisions for children who have been excluded from health insurance coverage because insurers did not want to accept the risk of claims for known health problems.

Insurers will be required to cover everyone under the age of 19, even when they have known health problems, as of September 23, 2010. The new provision will apply to health insurance plans that are “grandfathered in”as well as to new group plans, self-insured plans and new individual plans. It applies to anyone under the age of 19 regardless of whether they are employed or married.

Texas residents over the age of 19 with known health problems have had access to coverage through a high-risk state pool. Now those who have not had health insurance for the last six months, will also have access to health insurance through a federal Pre-existing Condition Insurance Plan.

Is An Ounce Of Prevention Worth A Pound Of Cure?

That famous quote from Benjamin Franklin, “an ounce of prevention is worth a pound of cure,” will finally be put to the test this fall. New Texas health insurance plans, starting on September 23, must provide “recommended” preventative services without requiring you to cover co-insurance, co-payment or a deductible.

With access to health screenings that are no longer cost-prohibitive, we can catch deteriorating health earlier to prevent suffering and save lives. Of course, it’s also cheaper to reverse health problems before they become life threatening, and that can help make health care accessible to more people by using healthcare dollars more effectively.

How Does Healthcare Reform Increase Coverage For Children?

On September 23, insurers have to allow children who do not have insurance through their own employment to be covered with their parents’ insurance until the children become 26. It doesn’t matter whether the kids are married or whether their parents’ have individual health insurance, new employer plans or existing employer plans.

It also will not matter if children under the age of 19 have any known health problems. As of September 23, all health insurance plans in Texas, whether the policies are new or old, will no longer be allowed to deny health insurance to sick children under the age of 19.

How Does Healthcare Reform Aid Adults?

It establishes an insurance pool, the Pre-Existing Conditions Insurance Plan or PCIP, for adults with known health problems who do not have health insurance. This pool is designed to help uninsured adults get insurance at premium rates that are same as the standard market rates. That can end discrimination against those who are sick, and it means no more high premiums when you need medical care the most. Texas also has a state high-risk pool so if you are in that pool, you cannot transfer to the federal pool.

Does your health insurance limit your lifetime benefits? That, too, will change on September 23. Insurers will no longer be permitted to limit lifetime benefits that are defined to be “essential health benefits,” such as ambulance service and hospitalization. More services may be added to the classification of essential benefits because the details are still being discussed. No new Texas health insurance plans may be issued after September 23 with either annual or lifetime limits on benefits. Policies issued before that date will also have to be upgraded to remove annual limits by 2014.

If you have been waiting for your chance to benefit from the protection of Texas individual health insurance or Texas family health insurance, this fall will mark the beginning of a shift in how our country, and your state, responds to the need for medical care.

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