Securing health insurance in Texas can be challenging for low-income families, even if a member of the family has insurance available through work. That employer may not offer family or spouse coverage, or if they do, the premiums may be more than the worker can really afford. Going through private Texas health insurance plan may be even more expensive, with higher premiums, deductible amounts and co-pays. For more information on getting affordable health insurance please visit: https://www.texasquotes.com/health-insurance/.
Fortunately, the health insurance landscape in Texas includes a solution in the form of the Health Insurance Premium Payment program or HIPP. In order to qualify for this state program, at least one member of the family must be receiving Medicaid coverage, and must also be eligible for employer-sponsored coverage. For eligible participants, HIPP will provide direct assistance for the premiums for employer-sponsored coverage.
The assistance comes in the form of a simple reimbursement. A HIPP-eligible worker pays the required premiums out of his paycheck. The worker then sends a copy of the paystub showing the premium amount to the HIPP administrator. The HIPP program then sends a check to the worker for that amount or, if the employer agrees, provides the payment to the employer, in effect directly subsidizing the insurance premium.
The program works in cooperation with Medicaid, the public health insurance program in Texas and other states that provides medical services to low-income individuals and families. In a HIPP-eligible family, the spouse or child who is enrolled in Medicaid can still use the full range of Medicaid services, including doctor visits, immunizations, preventive care, emergency services and hospitalization. Providers are not obligated to care for Medicaid patients, and will notify prospective patients if they don’t. If a medical service is offered and provided, the physician or hospital bills Medicaid directly rather than the patient.
It’s important to note that if a patient who is eligible or covered by Medicaid and the HIPP-paid insurance visits a physician who will not accept Medicaid, that patient must pay any co-pay or deductible amounts out of his or her own pocket. Also, if a family member is not on Medicaid, but is only covered by the HIPP-paid insurance, the same holds true: all co-pays and deductibles must be paid by the patient.
The HIPP program places no restriction on the age of spouses or dependents; the single and simple criteria applied is that someone in the family must be eligible for Medicaid. In Texas, Medicaid health insurance is available for individuals or families who don’t exceed a certain income level, expressed as a percentage of the federal poverty level. This guideline varies according to age of children, and is also higher for pregnant women; check the federal website Medicaid.gov, or the state site run by the Texas Health and Human Services Commission for the latest information on Medicaid guidelines.
The HIPP program also has some guidelines for employer-sponsored insurance. The maximum lifetime benefit must be at least $500,000. This is the total amount the policy will pay over the lifetime of the individual covered. In addition, the insurance must pay at least 60 percent of the cost of doctor visits, medicines, tests, and hospital stays.
Texas workers interested in the HIPP program should check with their employers to go over the plan benefits and costs for family members. Some company plans will allow enrollment in the program at any time during the year; others restrict new signups to an “open enrollment” period. The HIPP administrator recommends that workers file their applications a month before that open enrollment program begins, in order to ensure plenty of time to get the HIPP application processed and approved.