There are plenty of options for your situation, but the private insurance market is probably not one of them.

Health insurance markets are, by design, constructed so that the monthly premiums that the younger, healthy people pay will go toward the expenses of those who contract illnesses or have accidents. Simple as that. That’s the reason why an insurance carrier can and will either place an exclusion waiver on the condition if you attempt to apply or they will just decline you altogether. These policies are generally much less expensive than the other alternatives for those who did not elect to participate in the health insurance marketplace.

If you need medical treatment and do not have coverage, you generally have three options in the great State of Texas:

1) The  Texas High Risk Pool. This is a group insurance pool for higher risk individuals that currently do not have coverage. You must not have current coverage and must meet the general eligibility requirements to gain entry. Be careful though, if you have not had coverage elsewhere within the last 63 days, then you must wait one year before your pre-existing condition is covered.

2) The  PCI Plan: This is a program created in Spring of 2010 from the Affordable Care Act and it stands for the Pre-Existing Health Insurance Plan. This plan is very cost effective and has no waiting periods on pre-existing conditions. The eligibility requirements are that you must not have been covered by another insurance carrier within the last 6 months and you must have a pre-existing condition.

3)  Texas Medicaid: This program is designed to provide inexpensive coverage to those who are near or below the poverty level. Eligibility is based primarily on income and assets, so this will not work for the majority of Texans.

Overall, the best way to approach medical care is to stay continuously covered by health insurance. If you have a lapse in coverage of over 63 days, then you may have created a problem regarding a new medical condition or with your existing conditions.

Please feel free to call us at 866.270.6209 with any questions on this topic and we’ll be happy to place you with the best option for your needs. As always, our services are provided at no charge to our clients.