Safe Care and Prior Authorizations

From overtesting and overdiagnosis to overtreatment, health care waste and unsafe care contribute not only to patient harm but also to unnecessary costs. Health plans are committed to reducing these burdens by utilizing tools such as prior authorization and post-utilization review, which are designed to ensure treatments are necessary, evidence-based, and safe. However, efforts to limit or eliminate these processes negatively affect affordability, safety, and quality for everyone. By maintaining a focus on reducing waste and enhancing safety, we can ensure that Texans receive the high-quality care they deserve.

Featured Resources

One-Pager: Medical Management Means Smart Care for Texas Patients

A Critical Gap: The Need for Stronger Health Care Fraud and Abuse Protections in Texas

Additional Resources

All

Policy Papers

TAHP Presentations

101s

Testimonies

Comment Letters

Legislative Briefs

News

Testimony in Opposition to SB 2450 (Medicaid Vision Mandate) 4.30.25

SB 1525 Oppose One-Pager – Blanket Prior Auth Limits Jeopardize Safety and Open the Door to Dangerous Prescribing

Testimony on SB 1525 (No Prior Authorization for Chronic Medications) 4.23.25

Testimony in Support of HB 4012 (Health Insurance Fraud, Waste, and Abuse) 4.17.25

Testimony Opposing HB 1635 (Prudent Layperson Standard) 4.17.25

HB 1635 Oppose One-Pager – Blocking Fraud Detection Undermines Prudent Layperson Protections

Testimony on SB 547 (PA Gold Carding Reporting Mandate) 4.9.25

Testimony Opposing SB 1380 (Ban on PAs for Several Services) 4.9.25

Testimony Opposing HB 3812 (TMB Prior Authorization Overreach) 4.9.25

Prior Authorization Testimony for House Insurance 9.5.24

A Critical Gap: The Need for Stronger Health Care Fraud and Abuse Protections in Texas

Electronic Filing of Prior Authorization Benefits Patients and Providers

TAHP Opposes HB 907: Don’t Eliminate Protections of Prior Authorization

One-Pager: Medical Management Means Smart Care for Texas Patients

Testimony Opposing SB 1150: One Prior Authorization for 12 Months

SB 1525 Oppose One-Pager – Blanket Prior Auth Limits Jeopardize Safety and Open the Door to Dangerous Prescribing

One-Pager: Medical Management Means Smart Care for Texas Patients

Testimony in Opposition to SB 2450 (Medicaid Vision Mandate) 4.30.25

Testimony on SB 1525 (No Prior Authorization for Chronic Medications) 4.23.25

Testimony in Support of HB 4012 (Health Insurance Fraud, Waste, and Abuse) 4.17.25

Testimony Opposing HB 1635 (Prudent Layperson Standard) 4.17.25

HB 1635 Oppose One-Pager – Blocking Fraud Detection Undermines Prudent Layperson Protections

Testimony on SB 547 (PA Gold Carding Reporting Mandate) 4.9.25

Testimony Opposing SB 1380 (Ban on PAs for Several Services) 4.9.25

Testimony Opposing HB 3812 (TMB Prior Authorization Overreach) 4.9.25

Prior Authorization Testimony for House Insurance 9.5.24

Testimony Opposing SB 1150: One Prior Authorization for 12 Months

A Critical Gap: The Need for Stronger Health Care Fraud and Abuse Protections in Texas

Electronic Filing of Prior Authorization Benefits Patients and Providers

TAHP Opposes HB 907: Don’t Eliminate Protections of Prior Authorization

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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: