In Texas, people can have both private insurance and Medicaid, a government-sponsored health insurance program. This is called dual coverage. To qualify for dual coverage, you must meet certain income and eligibility requirements. Dual coverage can help you save money on healthcare costs by covering expenses that your private insurance doesn’t cover. You can apply for dual coverage online or by contacting your local Medicaid office.
Am I Eligible for Medicaid in Texas?
Medicaid is a government health insurance program that helps people with low income and few assets pay for medical care. In Texas, Medicaid is called STAR, which stands for State of Texas Access to Medicaid. To be eligible for Medicaid in Texas, you must meet certain requirements, including:
- Be a Texas resident.
- Be a U.S. citizen or eligible immigrant.
- Have a low income. For most adults, this means earning less than $17,774 per year.
- Have limited assets. For most adults, this means having less than $2,000 in assets, not counting a home, car, and some other personal belongings.
- Be pregnant, a child under 19, a parent or caretaker of a child under 19, blind, or disabled.
There are also special Medicaid programs for people with specific health conditions, such as breast cancer or HIV/AIDS. To learn more about these programs, visit the Texas Health and Human Services website.
| Income Limit | Asset Limit |
|---|---|
| $17,774 per year for adults | $2,000 for adults |
| $36,156 per year for a family of four | $3,000 for a family of four |
Medicaid Benefits in Texas
Medicaid is a government-funded health insurance program that provides medical coverage to individuals and families with low incomes and resources. In Texas, Medicaid is administered by the Health and Human Services Commission (HHSC). To qualify for Medicaid in Texas, individuals must meet certain eligibility criteria, including income and asset limits. Once eligible, individuals can receive a variety of benefits, including:
- Medical care, such as doctor visits, hospital stays, and prescription drugs
- Mental health care, including therapy and counseling
- Substance abuse treatment
- Dental care
- Vision care
- Long-term care, such as nursing home care or home health care
- Family planning services
- Transportation to medical appointments
Can You Have Private Insurance and Medicaid in Texas?
Yes, it is possible to have private insurance and Medicaid in Texas. This is known as dual coverage. Dual coverage can be beneficial because it can help to cover the costs of medical care that are not covered by Medicaid. For example, Medicaid may not cover the cost of a private room in a hospital, but private insurance may. Dual coverage can also help to provide access to a wider range of providers. Medicaid recipients can choose to see doctors and other providers who accept Medicaid, while those with private insurance can choose to see providers who accept their private insurance.
How to Get Dual Coverage in Texas
To get dual coverage in Texas, you must first apply for Medicaid. You can apply online, by mail, or in person at your local HHSC office. Once you are approved for Medicaid, you can then purchase a private health insurance policy. There are a number of private health insurance companies that offer plans that are compatible with Medicaid. When you purchase a private health insurance policy, you will need to choose a plan that meets your needs and budget.
| Income | Asset Limits | |
|---|---|---|
| For a single person: | $1,482 per month | $2,000 |
| For a family of two: | $2,013 per month | $3,000 |
| For a family of three: | $2,544 per month | $4,000 |
| For a family of four: | $3,075 per month | $5,000 |
Changes in Income or Family Size
If your income or family size changes, you must report it to the state. This is because your eligibility for Medicaid is based on your income and family size. If your income goes up, you may lose your Medicaid coverage. If your family size increases, you may become eligible for Medicaid.
You can report changes to your income or family size by calling the Texas Health and Human Services Commission (HHSC) at 1-877-541-7905. You can also report changes online at the HHSC website.
It is important to report changes to your income or family size as soon as possible. If you do not report changes, you may have to pay back any Medicaid benefits that you received while you were not eligible.
- If your income goes up:
- You may lose your Medicaid coverage.
- You may be able to get private insurance.
- If your family size increases:
- You may become eligible for Medicaid.
- You may be able to get a larger subsidy for private insurance.
| Family Size | Income Limit |
|---|---|
| 1 | $17,655 |
| 2 | $23,790 |
| 3 | $29,925 |
| 4 | $36,060 |
| 5 | $42,195 |
| 6 | $48,330 |
Who is Eligible for Medicaid in Texas?
To qualify for Medicaid in Texas, you must be in one of the following categories: low-income families, pregnant women, people with disabilities, or people who are 65 or older.
How to Apply for Medicaid in Texas
To apply for Medicaid in Texas, you can submit an application online or by mail. Here are the steps involved in applying for Medicaid in Texas:
- Gather the necessary documents. You will need to provide proof of your identity, income, and residency.
- Complete the application form. The application form is available online or at your local Medicaid office.
- Submit your application. You can submit your application online, by mail, or in person at your local Medicaid office.
- Wait for a decision. You will receive a decision on your application within 45 days of submitting it.
Private Insurance and Medicaid in Texas
You can have both private insurance and Medicaid in Texas. However, your Medicaid benefits will be limited. Medicaid will only pay for services that are not covered by your private insurance.
Medicaid Waiver Programs
Texas also has a number of Medicaid waiver programs that provide additional coverage for people with disabilities and other special needs.
Medicaid Waiver Programs in Texas Program Eligibility Benefits STAR+PLUS Waiver Children and adults with intellectual and developmental disabilities Home and community-based services, such as personal assistance, respite care, and supported employment TxHmL Waiver Children and adults with physical disabilities Home and community-based services, such as personal assistance, respite care, and home modifications Community First Choice Waiver Adults 65 and older and people with disabilities Home and community-based services, such as personal assistance, respite care, and adult day care Hey folks, thanks so much for taking the time to read all about the ins and outs of having both private insurance and Medicaid in the great state of Texas. I know it can be a bit of a head-scratcher, but hopefully, this article shed some light on the subject. If you’ve got any other insurance-related questions, feel free to drop me a line. And be sure to check back in the future for more informative articles on all things health and insurance. Until then, take care and stay healthy, y’all!