Health Care Coverage Options & Adult Providers
Finding health care coverage as an adult:
Texas Health Options : This is a great place to start learning of your health care coverage options.
Texas Health Options is a comprehensive website for finding health care coverage, including low-cost options, and is a resource provided by the State of Texas.
You first “Select Your Profile” and then it will delineate options for health care coverage that best match your profile and health coverage needs.
Depending on the profile you select for yourself, Texas Health Options will suggest certain steps to take in order to get health care coverage, and it will provide more detailed information on the steps.
Some of the steps Texas Health Options may suggest might be, but are not limited to, the following:
If you’re covered on a parent’s policy, try to continue this coverage if possible.
Find-out if your college or university offers a student health plan. (The website lists college/university links to coverage.)
Seek coverage through your employer (some employers offer coverage to part-time employees).
If you’re seriously disabled, apply for Social Security Disability Income.
Supplemental Security Income (SSI)
For disability purposes in the SSI program, a child becomes an adult at age 18, and the Social Security Administration uses different medical and nonmedical rules when deciding if an adult can get SSI disability payments. For example, the Social Security Administration does not count the income and resources of family members when deciding whether an adult meets the financial limits for SSI. They count only the adult’s income and resources. They also use the disability rules for adults when deciding whether an adult is disabled.
If your child is already receiving SSI payments, the Social Security Administration must review the child’s medical condition when he or she turns age 18. They usually do this review during the one-year period that begins on your child’s 18th birthday. They will use the adult disability rules to decide whether your 18-year-old is disabled. If your child was not eligible for SSI before his or her 18th birthday because you and your spouse had too much income or resources, he or she may become eligible for SSI at age 18. If a recipient has SSI, they will also have Medicaid for health care coverage.
In order to learn more about SSI, go to www.ssa.gov/pubs/11000.html. It will provide comprehensive information about the program, including benefits, eligibility criteria, and the application process.
In order to prepare your SSI application, you may get “Disability Starter Kits” which provide a fact sheet, application checklist and worksheet.
Social Security Disability Income (SSDI)
An adult child also may qualify for benefits on a parent’s earnings record if he or she has a disability that started before age 22 and one of his or her parents must: be receiving Social Security retirement or disability benefits; or must have died & have worked long enough under Social Security. The recipient will also receive Medicaid coverage.
If you don’t qualify for health care coverage through options such as trying to remain on your parent’s health care insurance plan or obtaining coverage through an employer or college/university or if you don’t qualify for SSI/SSDI ( which entitle you to Medicaid), then there are options such as:
The County Indigent Health Care Program
www.dshs.state.tx.us/cihcp/default.shtm (Find your local office at this link.)
The County Indigent Heath Care Program (CIHCP) is a part of the Texas Department of State Health Services (TDSHS) and provides health care services to eligible residents through the counties, hospital districts and public hospitals in Texas. Counties are required to provide Basic Health Care Services and may elect to provide a number of TDSHS–established Optional Health Care Services.
Parkland Health care System is the County Indigent Health Care Program for Dallas county residents only.
In order to learn more about the Parkland Community Health Plan, go to www.parklandhospital.com/patients_visitors/healthplan.html.
The Epilepsy Foundation
If you have been diagnosed with epilepsy or a seizure disorder and do not have health insurance (they also accept Medicaid), the Epilepsy Foundation offers specialized medical care and diagnostic testing at their clinics for adults with epilepsy . All of the clinics are funded in-part by a grant from the Texas Department of Health Services. Clinic sites are located in Amarillo, Beaumont, Fort Worth, Grapevine, Houston, Lubbock, & Lufkin. The Epilepsy Foundation Clinic also can help patients with obtaining their seizure medication at low or no cost, if they qualify.
Other Community Clinics
There are other clinics in the community which provide health care; however, they most often provide primary care & don’t often provide specialty care like neurology. They charge fees based on what you can afford. They may have samples of medications but often can’t provide medication assistance, especially for medications to treat a chronic condition.
You may find community clinics in your area by utilizing these resources:
http://datawarehouse.hrsa.gov/nhscdetail.aspx - The Department of Health and Human Services’ Bureau of Primary Health Care’s Provider Locator helps find a primary care provider in your area.
2-1-1 Texas - Call 2-1-1 (or go to www.211.org)
If you have no medication coverage as part of your health care coverage, there are some pharmaceutical assistance programs which may be able to provide assistance:
Partnership for Prescription Assistance
Partnership for Prescription Assistance unites America’s pharmaceutical companies, doctors, patient advocacy organizations, and civic groups to help low-income patients without prescription coverage.
Rx Hope provides access to applications for various national pharmaceutical assistance programs.
Rx Outreach provides more than 50 generic medications that treat a wide range of conditions to people who financially qualify.
Texas Rx Card Program
Texas Rx Card Program free prescription drug discount card for Texas residents.
Rx Assist gives providers access to pharmaceutical company patient assistance programs.
National Organization of Rare Disorders Medication Assistance Programs
National Organization of Rare Disorders Medication Assistance Programs assists uninsured or under-insured individuals in securing life-saving or life-sustaining medications.
Finding health care providers (i.e. physicians and advanced practice providers)
If you receive Medicaid, then the Texas Medicaid and Health care Partnership has a “provider look-up” by which you may find primary care, neurology and other specialty providers who accept patients with your form of Medicaid and who are located close to you.
If you have another form of health care insurance coverage, then you may search for providers through your health care insurance provider. Health care insurance plans have various ways by which to search for a provider, which is usually via an internet search on the health care insurance website or by calling a 1-800 number on your insurance card.
Also, many health care systems located close to you provide assistance in finding providers who are a part of their system and who accept your form of health insurance. For example, you may look-up neurologists who are associated with UT Southwestern by going to, http://www.utsouthwestern.edu/patientcare/doctor/findphysician.html