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Texas Department of Insurance
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Insurance for Texans with disabilities

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Choosing a health plan can be hard. Choosing a plan if you or a family member has a mental or physical disability can be even harder. In Texas, people with disabilities have legal protections when buying insurance.

Health insurance

Insurance companies must sell a health plan to anyone who applies during the open enrollment period. They will decide how much to charge you based on your age, where you live, whether you use tobacco, and how many people you want to cover. They may not consider your gender or health factors. They can’t deny you or charge you more because of a preexisting health condition or disability.

A health plan will pay only for medically necessary treatments. It may review treatments before or after you receive them to decide whether they’re medically necessary. If a plan denies your treatment, you can appeal the decision. Learn more about external reviews.

Mental health benefits

Most health plans must include benefits for mental health and substance use disorder services. These benefits must be provided at the same level as those for physical illness. Learn more about mental health parity.

Other types of insurance

Life, auto, and home insurance companies can’t refuse to sell you a policy or charge you more because of a disability, unless they can show that the disability increases the chances that you'll have a claim.

If a company won't sell you a policy, cancels, or refuses to renew your policy, ask why. Most auto and home insurance companies must tell you the reason in writing.

Filing a complaint

If you think an insurance company has treated you unfairly, you can complain to us. For more information, call our Help Line at 800-252-3439 or visit our website.

You can also complain to the federal Americans with Disabilities Act (ADA) Technical Assistance Center. For more information, visit the ADA Technical Assistance Center website or call 800-514-0301 or 800-514-0383 (TTY).

If you get health insurance through your job, file your ADA complaint with the Texas Workforce Commission's Civil Rights Division. For more information, visit the Workforce Commission's website or call 888-452-4778.

The Texas Legal Services Center can answer questions and help you find free and low-cost legal aid. Visit the Legal Services Center website or call the Legal Hotline for Texans at 800-622-2520. The hotline is for Texans over 60 who are on Medicare.

Health care coverage options

Most people have health coverage through their job or through a government health plan like Medicare, Medicaid, or a veterans' health program.

If you can’t get health insurance at work or through a government program, you can buy it from an insurance company. You can also buy it through the federal insurance marketplace. Depending on your household income, you may qualify for a subsidy to help with your premiums and lower your costs. Visit Healthcare.gov or call 800-318-2596.

Also read our guide for Health care coverage options for Texas children.

Medicare

Medicare is a federal health insurance program for people 65 or older and for some people under 65 with disabilities. Medicare pays for most, but not all, of your health care. To get Medicare because of a disability, apply through the U.S. Social Security Administration.

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

Learn more: How to pick the right Medicare plan

Medicare supplement insurance

Medicare supplement insurance pays some of the health care costs that Medicare won’t pay. You don’t have to buy Medicare supplement insurance, and you might not need it.

If you choose to buy a Medicare supplement policy, you buy it from an insurance company. Texas law requires Medicare supplement companies to make at least one plan available to people who are under 65 and on Medicare because of a disability.

You can buy Medicare supplement policies within six months after you enroll in Medicare. You’ll get another chance to buy a policy when you turn 65. You’ll have more choices then because you’ll be able to choose from all of the Medicare supplement plans companies offer. For more information, read our Medicare supplement insurance guide.

Medicare Advantage plans

Medicare Advantage plans are a type of Medicare health plan offered by insurance companies.

These plans provide at least the same coverage as original Medicare, and some might provide more. For instance, many Medicare Advantage plans provide vision, hearing, dental, and prescription drug coverage.

To join a Medicare Advantage plan, you must live in the plan's service area and be enrolled in Medicare Part A and Part B. Medicare Advantage plans use networks of providers to treat their members. This means your choice of doctors might be limited. There's more information about Medicare Advantage in our Medicare supplement insurance guide.

Medicaid

Medicaid is a state and federal health insurance program for people with lower incomes. The Medicaid buy-in program allows working Texans with disabilities to get Medicaid, even if they earn more than the Medicaid income limits. People in the buy-in program pay monthly premiums based on their income and other factors.

For information, visit the Texas Health and Human Services website or call the Medicaid hotline at 800-252-8263.



Question? Call us at 800-252-3439.

Last updated: 5/13/2022