Does Texas Health Insurance Work With Pre-existing Conditions?

Will the Patient Protection and Affordable Care Act help if you have health problems? The Pre-Existing Condition Insurance Plan is designed to help those who can't get health insurance.

Since health insurance in Texas is guided by different underwriting policies, it is possible to that your application would be accepted even after another insurer has refused to cover you. If that doesn't work, the federal government is putting up five billion dollars to help subsidize premiums for people unable to get health insurance for at least six months. Unfortunately, this coverage will not be available until 2014.

Does Texas Already Have A High-risk Insurance Pool?

While these risk pools are planned for every state, 22 state governments have decided to let the federal government run their high-risk pool. These states started to accept applications to join the pools on July 1, 2010.

Texas is one of 35 states that already have a high-risk insurance pool. If you were in this pool, you would not be allowed to switch to the new pool in 2014 until after you have experienced at least six months with no health care coverage.

The Texas Health Insurance Risk Pool had 26,478 enrollees as of November 2010. To be eligible, you must be legally residing in the United States or be a citizen or a national. As with the federal high-risk pool, you must have been without health coverage for at least the last six months. In addition, you must have been denied health coverage based on a pre-existing condition or currently have a pre-existing health problem.

High-risk Texas Insurance Plans Include Three Options

Three plan options are available through the Texas Health Insurance Risk Pool and the choices mean different premiums, deductibles for calendar years, prescriptions and prescription co-pay charges. You may also select a health savings account (HSA) option.

This is a special type of savings account that allows you to deposit money that earns interest tax-free. If you need the funds for health care expenses that are not covered, you can take a tax deduction for that expense. Most, but not all, healthcare expenses are allowed to be covered via an HSA and you never have to pay taxes on funds used to pay for qualified expenses. Alternative healthcare, such as acupuncture and homeopathy, are included in qualified withdrawals.

Texas Insurance Plans Provide Preventive Health Care

All of the high-risk pool plans include 100 percent coverage for preventive care without having to meet any deductible when in-network doctors indicate a preventive diagnosis. That includes an annual exam, cancer screenings like mammograms and routine flu shots.

For other forms of health care, 80 percent of the cost is covered after a deductible. The amount you could spend per calendar year is limited to $5,950 for services from providers in the network or to $7,000 for care received from out-of-network providers. The plans do not limit the amount of services covered throughout your lifetime.

Explore All Of Your Options For Health Insurance In Texas

Check with several different Texas health insurance providers to see if their underwriting standards permit covering health problems like your condition. In addition, independent insurance brokers are often more familiar with which companies are most likely to accept certain conditions. If you don't find the coverage you want on the open market, look for pre-existing condition insurance plans (PCIP) through the Texas health insurance pool.