Health Insurance

Getting Health Insurance from Government Programs

Medicare. If you are over 65 or have a disability you may be able to get health coverage through Medicare. The Texas Health Information, Counseling, and Advocacy Program can help you enroll in Medicare.

Medicaid. Medicaid and the Children’s Health Insurance Program (CHIP) provide health coverage for low-income children, families, seniors, and people with disabilities.

Service Members and Veterans. Active and retired military service members and their families may be able to get coverage through TRICARE. This is a federal health program run through the U.S. Department of Defense. Veterans can get health care directly through the Veterans Health Administration’s (VA) integrated health care system.

health insurance

How do you apply for government programs?

You can use YourTexasBenefits.gov’s Screener Tool to see if you qualify for Medicare, Medicaid, and CHIP.

The Aging and Disability Resource Center (ADRC) can help you find and apply for long-term care programs for seniors and people with disabilities. Contact them at 55-YES-ADRC (855-937-2372). The Texas Health Information, Counseling, and Advocacy Program can help you find information and enroll in Medicare, Medicaid, and long-term care. Contact them at 800-252-9240.

Terms to Know

Coverage/Benefits – The health care services that the health plan will pay for if you get hurt or sick. Coverage and benefits can include preventive care.

In-network – Health care services provided by a doctor or hospital that has an agreement with your health plan. You will usually pay less for in-network services.

Out-of-network – Health care services provided by a doctor or hospital that does not have an agreement with your health plan.

Policy – A contract between you and the insurance company. The policy tells you what’s covered and what the insurance company is required to pay.

Primary care physician (PCP) – Your personal doctor that provides basic health care services and coordinates your care by referring you to specialists.

Self-funded plans – Health plans operated by an employer (instead of the employer buying a health insurance plan). Self-funded plans are overseen by the U.S. Department of Labor.