Getting Texas Health Insurance With a Serious Medical Condition

6. If you have a serious medical condition or a disability...

...there are three main programs that may help you. Those programs are Medicare, Medicaid/TexCare and the Texas Health Insurance Risk Pool.

Medicare

You might qualify for Medicare, even if you are under age 65, if you have a disability that is expected to last at least a year or is expected to cause your death. In order to get Medicare because you are disabled, you have to apply for Social Security Disability Insurance (SSDI) and you must receive SSDI for 24 months before you can enroll in Medicare. Until that time, you will have to find another source of health insurance, like COBRA (see Sections #1 and #2) or one of the other options discussed below.

TO LEARN MORE about SSDI, call the Social Security Administration's toll-free number at 1.800.772.1213 (1.800.325.0778 TTY). To learn more about Medicare, call 1.800.MEDICARE (633.4227) or go to www.medicare.gov.

Medicaid

If you are blind or have a disability and your income is low or you spend most of your income on health care, you may qualify for Medicaid. People who have a disability usually qualify for Medicaid because they get Supplemental Security Income (SSI), but you may be able to get Medicaid while you are waiting to find out if you are eligible for SSI. Even if you do not qualify for SSI, you may still be able to get health insurance through Medicaid.

TO LEARN MORE about the rules and how to apply, contact the Texas Medicaid program toll-free line at 1.800.252.8263 (1.800.735.2988 TTY).

Texas' High-Risk Pool for People with Health Problems

High-risk pools are state-run programs that sell health insurance to a small number of people who are turned away by insurance companies or are offered very limited or expensive policies because they or a family member have an existing health problem.

TO LEARN MORE about Texas' high-risk pool, the Texas Health Insurance Risk Pool, call 1.888.398.3927 or visit www.txhealthpool.org.

Find out if you qualify, which services are covered and how much it costs.

More Help Finding Your Way

Because these programs are so complicated, you may want help. For example, many people are turned down for Medicare or Medicaid coverage the first time they apply. You may need to appeal this decision more than once. The following may be able to help:

• You can call Texas Legal Services Center at 1.800.622.2520 or visit www.tlsc.org to find the legal services office that is closest to where you live. You can also check www.lsc.gov.
• State Health Insurance Assistance Programs (SHIPs) provide information, counseling, and assistance to Medicare beneficiaries. Contact Texas' SHIP, the Health Insurance Information Counseling and Advocacy Program (HICAP), by calling 1.800.252.9240.
• Protection and Advocacy (P&A) programs provide legal representation and other advocacy services under all federal and state laws to all people with disabilities. In Texas, contact Advocacy, Inc. at 1.800.252.9108 (512.454.4816 TTY) or visit www.advocacyinc.org.