What to Know About Low Income Health Insurance in Texas
Children’s Medicaid and the Children’s Health Insurance Program (CHIP) offer health insurance options for low income youth in Texas.
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Adults have limited options for low income health insurance in Texas. It's extremely difficult to qualify for Medicaid in Texas as an adult.
Community health centers and low-cost health insurance plans might be options if you don't meet the Medicaid requirements. If you make at least $14,580 per year, you might get free or low-cost health insurance from the federal marketplace.
Texas low income health insurance income limits
Texas has several low income health insurance programs. To qualify, you can only make up to the income limit, which varies based on the number of people in your household.
Depending on your income, children in your family might qualify for Medicaid in Texas, even if the adults don't.
Low income health insurance program | Monthly income limit for a family of three |
|---|---|
| Medicaid for adults in the household | $344 |
| Medicaid for children | $2,756 |
| Medicaid for pregnant women | $4,260 |
| Medicaid for breast and cervical cancer | $4,303 |
| CHIP for children | $4,325 |
| CHIP for pregnant women | $4,346 |
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A household with three people can make up to $2,756 per month and still get Medicaid for their child. But for adults to qualify, a family of three can make no more than about $344 per month.
Medicaid for low income adults in Texas
Most adults without children are not eligible for Medicaid in Texas.
Parents, seniors and people with disabilities are eligible, but qualifying for Medicaid as an adult in Texas is difficult. The requirements are based on monthly income and vary based on the number of people in your household. A family of three, for example, can make no more than about $344 per month and must meet other requirements.
Pregnant women in Texas have two different program options for low income health insurance, and it's easier to qualify than it is for other adults.
Adults who have been diagnosed with breast or cervical cancer may have an easier time qualifying for Medicaid in Texas. To qualify, single individuals can make up to $2,510 per month ($30,120 per year), which is 200% of the federal poverty level. For a family of three, the cap is $51,640 per year. You also have to meet other requirements.
- Are between 18 and 64
- Are a U.S. citizen or eligible immigrant
- Live in Texas
- Have no other health insurance
- Need breast or cervical cancer treatment
If you have a low income but your whole family doesn't qualify for Medicaid, there are three ways to get cheap health insurance or medical care.
- Get a health insurance plan through the marketplace where plans can cost as little as $0 per month if you earn at least $14,580 per year as an individual.
- Get health insurance through a job, where individuals typically pay about 17% of the policy cost. That's an average of $117 per month deducted from your paycheck.
- Look at other coverage options such as a short-term health insurance plan, which typically covers you if you get very sick but doesn't usually pay for routine care, or use a community health center to get discounted medical care without insurance.
Medicaid expansion in Texas
It's more difficult to qualify for Medicaid in Texas than in other states because Texas has not expanded Medicaid.
That means there is a coverage gap where an estimated 772,000 people in Texas make too much to qualify for Medicaid but make too little to get premium subsidies on the federal health insurance marketplace. Texas has the largest coverage gap in the country.
A senior in Texas usually has to make less than $11,144 per year to qualify for Medicaid. That's 26% below the federal poverty level. Seniors also have to meet other requirements, such as being enrolled in Medicare Part A. However, in the 40 states with expanded Medicaid, a single person can make up to $20,783 per year and still qualify without meeting other requirements.
Texas Children's Medicaid
Children's Medicaid can provide low-cost or free health insurance in Texas.
Children's Medicaid is the best low income health insurance for children in Texas. Medicaid covers about 38% of the children in Texas. The program provides coverage for most common health care services.
- Checkups at the doctor
- Dental visits
- Medicine and vaccines
- Hospital care and services
- X-rays and lab tests
- Vision and hearing care
- Access to medical specialists
- Access to mental health care
- Special health needs
- Pre-existing conditions
When your child is covered by Medicaid in Texas, doctor visits and medicine costs between $3 and $35.
Children's Medicaid in Texas also covers some forms of long-term care for children with disabilities, which sets it apart from the other low income health insurance programs in Texas.
- Home care and personal care
- Transportation to medical appointments
- Nursing home care
- Hospitalization for mental illnesses
- Care for children with intellectual disabilities
To qualify, a child must be under 18, although some 19- and 20-year-olds with disabilities qualify. A child must also be a Texas resident and either a U.S. citizen or a qualified noncitizen.
There are also monthly income caps for Children's Medicaid.
Texas Children's Medicaid income limits
People in household | Monthly income limit |
|---|---|
| 1* | $1,669 |
| 2 | $2,265 |
| 3 | $2,862 |
| 4 | $3,458 |
| 5 | 4,054 |
*A single household member is a child who doesn't live with a parent or relative.
If your household has more than eight people in it, add $596 to the income limit for each additional person.
If you make too much for your child to qualify for Children's Medicaid, your child may qualify for the Texas Children's Health Insurance Program (CHIP).
Medicaid unwinding in Texas
About 1.8 million people in Texas, including more than a million children, were disenrolled from Medicaid this past year during the Medicaid unwinding.
Medicaid disenrollments in Texas were largely because of paperwork issues such as an incomplete renewal form or a non-updated address. Contact the Texas Health & Human Services Commission to see if you are still eligible for Medicaid and to re-enroll.
Children's Health Insurance Program (CHIP) in Texas
If your income is too high to qualify for Children's Medicaid, the Children's Health Insurance Program (CHIP) may be a good option.
Texas CHIP coverage is similar to Children's Medicaid but does not include any coverage for long-term disability support or services.
Health care with CHIP is nearly as cheap as with Medicaid, and a child's doctor appointment could cost between $5 and $25.
Children must be 18 or under, Texas citizens and either U.S. citizens or qualified noncitizens. The income limits for CHIP are higher than those for Children's Medicaid. This means you can make more money and still qualify for the Texas Children's Health Insurance Program.
CHIP income limits in Texas
People in household | Monthly income limit |
|---|---|
| 1* | $2,523 |
| 2 | $3,424 |
| 3 | $4,325 |
| 4 | $5,226 |
| 5 | $6,127 |
*A single household member is a child who doesn't live with a parent or relative.
Households with more than seven people should add $901 per person to the income limit.
Low income health insurance for pregnant women in Texas
Pregnant women in Texas have two options for low income health insurance: Medicaid for pregnant women and CHIP for pregnant women. The monthly income limit for CHIP is slightly higher, so it's easier to qualify.
Medicaid for pregnant women in Texas
Medicaid provides health insurance coverage for low income pregnant women in Texas.
Medicaid for pregnant women in Texas covers services including::
- Prenatal doctor visits
- Prenatal vitamins
- Labor and delivery
- Checkups for the baby after birth
To qualify, you must be a Texas resident and a U.S. citizen or qualified noncitizen.
You also have to meet monthly income requirements. The requirements vary based on how many people are in your household.
Texas Medicaid income limits for pregnant women
People in household | Monthly income limit |
|---|---|
| 1 | $2,485 |
| 2 | $3,373 |
| 3 | $4,260 |
| 4 | $5,148 |
| 5 | $6,036 |
For each person over five in the household, add $888 per month to the income limit.
CHIP for pregnant women
Pregnant women might also qualify for the Children's Health Insurance Program in Texas. If you are pregnant but make too much to qualify for Medicaid, you could consider CHIP Perinatal.
Medical care is cheap with CHIP Perinatal, and being admitted to the hospital for childbirth could cost between $35 and $125.
CHIP Perinatal and Medicaid cover similar things, including prenatal doctor visits, labor and delivery, and baby checkups after birth.
The income limits for CHIP Perinatal are slightly higher, which means you can make more and still qualify.
CHIP income limits for pregnant women in Texas
People in household | Monthly income limit |
|---|---|
| 1 | $2,535 |
| 2 | $3,441 |
| 3 | $4,346 |
| 4 | $5,252 |
| 5 | $6,158 |
For households with more than five members, add an additional $906 per month per person.
Getting Medicaid in Texas if you have high medical bills
Children and pregnant women with high medical bills, the may use the Medicaid spend down program to meet the qualifying income criteria. In the spend down program, your medical costs are deducted from your income, and this new amount is used to see if you meet Medicaid's income criteria.
To get Medicaid spend down in Texas, you first must apply for Medicaid and be rejected. Then you or your doctor can submit medical bills, and you'll work with Medicaid to calculate your adjusted income using Form H1119.
Other low income health insurance options in Texas
If you don't qualify for Medicaid or CHIP, there are other options for low income health insurance in Texas.
Vaccines for Children program
If you or your child are 18 or under, the Texas Vaccines for Children program is a good way to get low-cost vaccinations. You or your child must be one of the following to qualify.
- Covered by Medicaid
- Covered by CHIP
- Uninsured
- Underinsured
- Of American Indian or Alaska Native heritage
Community centers
Community health care centers don't sell insurance. But they do offer low-cost health care. If you can't afford insurance, a community center can be a good way to get the health care you need.
Find a community health center near you through Texas Association of Community Health Centers or through the government's health center tool.
If you go to a Federally Qualified Health Center (FQHC), you might get discounted health care. Fees are adjusted based on your income and family size.
A Federally Qualified Health Center also cannot deny your care just because you can't afford to pay.
Alternative health plans
An alternative health plan is any plan that doesn't work like traditional health insurance.
Alternative health plans include short-term health insurance, limited benefit plans and health care sharing ministries.
These plans may limit the length of your coverage or only cover certain situations. Some alternative plans are not regulated by the state, so there's no guarantee that claims will be paid. While these plans can be a good option if you have no other choice, make sure you research them carefully and understand their limitations.
Cheap health insurance on HealthCare.gov
If you don't qualify for Medicaid, you could get free or cheap health insurance through HealthCare.gov.
In most cases, the cost of insurance is discounted based on your income because of premium subsidies.
To qualify, you have to make at least the federal poverty level based on your household size.
Minimum income to be eligible for health insurance subsidies
People in household | Federal poverty level |
|---|---|
| 1 | $14,580 |
| 2 | $19,720 |
| 3 | $24,860 |
| 4 | $30,000 |
| 5 | $35,140 |
For families with more than eight people, add $5,140 for each additional person.
Rates are set on a sliding scale. That means health insurance is free for individuals earning between $14,580 and $21,870. A family of three can make between $24,860 and $37,290 and get a free plan.
If you earn more, you'll pay more. So an individual in Texas earning $30,000 per year will pay about $50 per month for a typical health insurance plan.
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In Texas, it is possible to earn too much to qualify for Medicaid or CHIP, but too little to qualify for federal subsidies. This coverage gap happens in states that have not expanded their Medicaid program under the Affordable Care Act (ACA). Texas is one of 10 states that have not expanded Medicaid to provide access to affordable health insurance for all people who have a low income..
Frequently asked questions
What is the best low income health insurance in Texas?
Medicaid is the best low income health insurance in Texas for children, but it's very difficult for adults to qualify. If you do qualify, Medicaid is a good option. If you make too much to qualify for Medicaid, you could buy an alternative health plan, get health care at a community center or look for cheap traditional health insurance.
What company has the cheapest health insurance in Texas?
Aetna has the cheapest health insurance in Texas. If you don't qualify for Medicaid, you could consider buying a traditional health insurance policy. If you shop through HealthCare.gov, you might qualify for premium subsidies that can make your health insurance cheaper.
What is Texas STAR Medicaid?
If you have STAR Medicaid, also called managed care, your Medicaid benefits come from a health insurance company. In most parts of Texas, you'll have at least two companies you can choose from, which may include Amerigroup, Molina or Blue Cross Blue Shield. You'll then get your health care from doctors and hospitals within your company's network.
Sources
Sources include HealthCare.gov, the Kaiser Family Foundation, the Texas Department of State Health Services, the Texas Health & Human Services Commission and Texas.gov.
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