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Insurance for Texans with Disabilities

(March 2016)

(En Español)

Appeals and Independent ReviewHealth Care Coverage OptionsState and Federal Agencies for Texans with Disabilities

Texans with mental and physical disabilities have legal protections when buying and renewing insurance in Texas. 

When deciding what to charge you, health insurance companies may consider only your age, where you live, whether you use tobacco, and whether the coverage you’re buying is for an individual or a family. They may not deny coverage or charge you more because of your health status, including a preexisting condition or disability.

Life, auto, and homeowners insurance companies also can’t deny coverage or charge you more because of a disability, unless the company can show that the disability increases the chances that you'll have a claim.

The federal Americans with Disabilities Act (ADA) provides additional protections. For more information, visit the ADA Technical Assistance Center website at 1-800-514-0301 or 1-800-514-0383 (TTY).

If a company won't sell you a policy, cancels, or refuses to renew your policy, ask why. Most auto and homeowners companies must give you the reason in writing. The company must explain exactly what incident, circumstance, or risk factor it used to decide. The company must also tell you its sources of information.

If you think an insurance company has treated you unfairly, file a complaint with the Texas Department of Insurance. For more information, call TDI's Consumer Help Line at 1-800-252-3439 or visit our website.

You can also file a complaint with the ADA Technical Assistance Center. If you get health insurance through your employer, you must file your ADA complaint with the Texas Workforce Commission's Civil Rights Division. For more information, visit the Workforce Commission's website or call 1-888-452-4778.

If you need legal help, the Texas Legal Services Center offers free information and helps people find free and low-cost legal aid. For more informaton, visit the Legal Services Center website or call the Legal Hotline for Texans at 1-800-622-2520. The hotline is for Texans over age 60 who receive Medicare.

Appeals and Independent Review

A managed care plan will pay only for treatments that are medically necessary. Your plan may review a treatment either before or after you receive it to determine whether it’s medically necessary. If a plan denies your treatment, you might be able to appeal the decision. For information about appeals, including how to get an independent review of the decision, read our Independent Review Organizations publication.  

Health Care Coverage Options

Most people must have health insurance that meets federal coverage standards or pay a tax penalty. Health plans provided by your employer and most state or federal government health plans (Medicare, Medicaid, CHIP, TRICARE, and some veterans' health programs) will usually satisfy the requirement.

You also can buy an individual plan to cover yourself, or yourself and your family. You can buy directly from insurance companies and agents or from the federal insurance marketplace. Visit the marketplace website or call 1-800-318-2596.

Medicare

Medicare is a federal health insurance program that pays health care costs for people who are 65 or older. It will also pay for health care for some people under age 65 who have disabilities. Medicare eligibility is determined by the Social Security Administration.

For more information about Medicare, visit the Medicare website or call 1-800-633-4227.

Medicare Supplement Plans

Medicare pays for most, but not all, of your health care. Medicare supplement insurance helps cover some of the costs that Medicare doesn’t pay. 

Medicare supplement policies are sold by private insurance companies that are licensed and regulated by TDI. Medicare supplement benefits, however, are set by the federal government.

It’s best to buy Medicare supplement insurance during your six-month open enrollment period. Your open enrollment period begins when you enroll in Medicare Part B at age 65 or older. During this time, companies can’t refuse to sell you a policy because of your health history or condition. If you wait until after your open enrollment period, you might not be able to get a policy if you have a preexisting condition. For more information about Medicare supplement insurance, read TDI's Medicare Supplement Insurance Handbook.

Medicare Advantage Plans

Medicare Advantage plans are alternatives to original Medicare. They help control costs by using provider networks. Your out-of-pocket costs in a Medicare Advantage plan might be less, but your choice of doctors could be limited. To be eligible to join a Medicare Advantage plan, you must live in a plan's service area, be enrolled in Medicare Part A and Part B and, in some plans, not have end-stage renal (kidney) disease. For more information, read our Medicare Advantage publication.

Medicaid Buy-In Program for Employees with Disabilities

Medicaid, a health insurance program for low-income Texans, has a buy-in program for employed people of any age with disabilities. The program allows Texans with disabilities to keep their Medicaid benefits, even if they earn more than the Medicaid income limits. To be eligible for the program, you can't earn more than $2,328 per month.

People in the buy-in program pay monthly premiums based on income and other factors. They get the same services as other people with Medicaid, including office visits, hospital stays, X-rays, vision and hearing services, and prescriptions.

For information about Medicaid and eligibility, visit the Texas Health and Human Services Commission website or call 1-800-252-8263.

State and Federal Agencies for Texans with Disabilities

The following state and federal agencies may have information helpful to Texans with disabilities:

Federal health insurance marketplace

1-800-318-2596
HealthCare.gov

The Office of Public Insurance Counsel advocates for consumers and represents them at rule hearings, legislative hearings, and court proceedings. The office can't represent individual consumers or resolve individual consumer complaints, but provides information to help you understand insurance.

1-877-611-6742
www.opic.texas.govwww.opic.texas.gov

Social Security's Supplemental Security Income provides basic needs assistance for people with little or no income

1-800-772-1213
1-800-325-0778 (TDD)
www.socialsecurity.gov/ssi/

Texas Department of Aging and Disability Services

512-438-3011
dads.state.tx.us

Texas Department of Assistive and Rehabilitative Services

1-800-628-5115
dars.state.tx.us

Texas Governor's Committee on People with Disabilities

512-463-5739
512-463-5746 (TDD)
http://gov.texas.gov/disabilities

Texas Department of State Health Services

1-888-963-7111
1-800-735-2989 (TDD)
dshs.state.tx.us

Texas Health and Human Services Commission

Call 2-1-1 for information about health and human services. The alternative number is 1-877-541-7905.
1-877-787-8999
1-888-425-6889 (TDD)
hhsc.state.tx.us

U.S. Department of Justice (Americans with Disabilities Act)

1-800-514-0301
1-800-514-0383 (TTY)
ada.gov

U.S. Equal Employment Opportunity Commission

1-800-669-4000
1-800-669-6820 (TTY)
eeoc.gov

U.S. Department of Veterans Affairs

1-800-827-1000
1-800-829-4833 (TDD)
www.va.gov

Get Help from TDI

For insurance questions or for help with an insurance-related complaint, call our Consumer Help Line at 1-800-252-3439 or visit our website.

Visit HelpInsure.com to shop for automobile, homeowners, condo, and renters insurance, and TexasHealthOptions.com to learn more about health insurance and your options for coverage.

The information in this publication is current as of the revision date. Changes in laws and agency administrative rules made after the revision date may affect the content. View current information on our website. TDI distributes this publication for educational purposes only. This publication is not an endorsement by TDI of any service, product, or company.



For more information contact:

Last updated: 03/23/2016

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Translation by WorldLingo


Translation by WorldLingo