Drug Coverage

Featured Resources

Texas Groups Oppose SB 1122 - ERISA Health Plan Mandates

Health Care Mandates 101 Presentation - 89th Session

TAHP Testimony Opposing SB 1122 (Applies 1919 & 1763 Rx Mandates) 3.5.25

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Comment Letters

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News

Testimony Opposing HB 3265 (340B Drug Pricing Mandate) 4.9.25

Testimony Opposing HB 2750 (Drug Coverage Carve-Out Mandate) 4.8.25

Health Care Mandates 101 Presentation – 89th Session

TAHP Testimony Opposing SB 1122 (Applies 1919 & 1763 Rx Mandates) 3.5.25

Texas Businesses Oppose SB 1122: Health Care Mandates Raise Costs on ERISA Plans

Texas Groups Oppose SB 1122 – ERISA Health Plan Mandates

Excessive Drug Mark-ups Are Costing Texas Patients

FDA Approves First State Plan to Import Drugs from Canada

New Texas Medicaid Law Protects Families from Drug Shortages

Scrutiny Grows on Pharma Patent Games

Now is the time for Texas to look for ways to reduce Big Pharma’s big prices

Texas Should Ban Efforts by Big Pharma to Manipulate Drug Costs

Medicaid Monday: Texas Medicaid MCOs Save Money on Prescription Drugs for Taxpayers

Texas Health Insurance Providers and PBMs Fight Out-of-Control Drug Prices

Texas Legislature Passes Prescription Drug Price Transparency Bill

Testimony On HB 755: One PA for 12 Months for Prescription Drugs

Testimony Opposing 2180: Point-of-Sale Rebates

Texas Businesses Oppose SB 1122: Health Care Mandates Raise Costs on ERISA Plans

Texas Groups Oppose SB 1122 – ERISA Health Plan Mandates

Health Care Mandates 101 Presentation – 89th Session

Testimony Opposing HB 3265 (340B Drug Pricing Mandate) 4.9.25

Testimony Opposing HB 2750 (Drug Coverage Carve-Out Mandate) 4.8.25

TAHP Testimony Opposing SB 1122 (Applies 1919 & 1763 Rx Mandates) 3.5.25

Testimony On HB 755: One PA for 12 Months for Prescription Drugs

Testimony Opposing 2180: Point-of-Sale Rebates

Excessive Drug Mark-ups Are Costing Texas Patients

FDA Approves First State Plan to Import Drugs from Canada

New Texas Medicaid Law Protects Families from Drug Shortages

Scrutiny Grows on Pharma Patent Games

Now is the time for Texas to look for ways to reduce Big Pharma’s big prices

Texas Should Ban Efforts by Big Pharma to Manipulate Drug Costs

Medicaid Monday: Texas Medicaid MCOs Save Money on Prescription Drugs for Taxpayers

Texas Health Insurance Providers and PBMs Fight Out-of-Control Drug Prices

Texas Legislature Passes Prescription Drug Price Transparency Bill

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1. How can I enroll in a health insurance plan during open enrollment?
Open enrollment for health insurance typically occurs annually from November 1 to December 15. During this period, you can enroll in or make changes to your health insurance plan through the Health Insurance Marketplace at HealthCare.gov. If you miss this window, you may qualify for a Special Enrollment Period due to certain life events, such as marriage, birth of a child, or loss of other coverage.

2. What are the health insurance options available in Texas?
Texans have several health insurance options, including:
  • Employer-Sponsored Insurance: Coverage provided by your employer.
  • Individual Plans: Purchased directly from insurance companies or through the Health Insurance Marketplace.
  • Government Programs: Such as Medicaid, the Children's Health Insurance Program (CHIP), and Medicare.
  • Short-Term Plans: Temporary coverage for specific periods.

3. Who is eligible for Medicaid and CHIP in Texas?
Medicaid: Available to low-income individuals, families, pregnant women, the elderly, and people with disabilities. Eligibility is based on income and household size.
CHIP: Provides health coverage for children in families that earn too much to qualify for Medicaid but cannot afford private insurance.
For detailed eligibility criteria, visit the Texas Health and Human Services website.

4. What is the Health Insurance Marketplace, and how does it work in Texas?
The Health Insurance Marketplace is a platform where individuals can compare and purchase health insurance plans. In Texas, the federal government operates the Marketplace through HealthCare.gov. You can compare plans, check for subsidies, and enroll during the open enrollment period.

5. Are there financial assistance options to help pay for health insurance?
Yes, depending on your income and household size, you may qualify for subsidies to lower your premiums and out-of-pocket costs. These include:
  • Premium Tax Credits: Reduce the amount you pay for insurance premiums.
  • Cost-Sharing Reductions: Lower your out-of-pocket costs for deductibles, copayments, and coinsurance.
Eligibility for these subsidies is determined through the Health Insurance Marketplace.

6. What should I consider when choosing a health insurance plan?
Consider these factors:
  • Premiums
  • Deductibles
  • Network of doctors and hospitals
  • Coverage of required medications and services
  • Out-of-Pocket Maximum
For more guidance, refer to the Texas Department of Insurance's Health Plan Shopping Guide.

7. What is a Special Enrollment Period, and how can I qualify?
A Special Enrollment Period (SEP) allows you to enroll in health insurance outside the annual open enrollment period if you experience certain life events:
  • Loss of Health Coverage
  • Household Changes (e.g. marriage, divorce, birth)
  • Residence Changes
To apply, visit HealthCare.gov.

8. How can I find out if my doctor is covered under a specific health plan?
Most insurance companies provide online directories of in-network providers. You can also contact the insurer directly or ask your doctor’s office to verify coverage.

9. Where can I get assistance with understanding and enrolling in health insurance?
Several resources are available: