Explainers
Getting Covered in Texas
- Coverage If You Lose Your Job in Texas: COBRA Against a Marketplace Plan
July 17, 2026
Losing job-based coverage opens two doors at once: COBRA and a Marketplace special enrollment period. How Texans work out the arithmetic between them.
- Medicare Basics for Texans: Turning 65 Without Coverage
July 9, 2026
Turning 65 uninsured in Texas: Parts A to D, the enrollment windows that carry lifetime penalties, and where the Medicare Savings Programs are decided.
- Short Term Plans and Health Shares: What Texas Regulators Say They Are Not
July 2, 2026
TDI's warning in plain terms: short-term plans, discount cards, and health care sharing ministries are not coverage, and often not regulated at all.
- Cost Sharing Reductions: The Silver Plan Rule and Why Bronze Can Cost More
June 25, 2026
Cost sharing reductions only attach to Silver plans, which is why a cheaper Bronze premium can leave a Texas household worse off across a whole year.
- Picking a Marketplace Plan in Texas: Deductible, Network, Formulary, Traps
June 16, 2026
Deductible against premium, network checks, drug formularies: the plan comparison steps that decide what a Texas Marketplace policy really costs you.
- Special Enrollment Periods: Getting Covered Outside Texas Open Enrollment
June 10, 2026
Missed open enrollment? A qualifying life event can still open the Marketplace. What triggers one in Texas, the proof requested, and where the deadlines sit.
- How Marketplace Subsidies Work: The FPL Band, the Benchmark Plan, and Tax Time
May 29, 2026
Premium tax credits run from 100% to 400% FPL again for 2026. The benchmark plan, the FPL band, and the reconciliation that catches people at tax time.
- Marketplace Plans in Texas: What Is Sold Here and How to Read It
May 22, 2026
What is actually sold on the Texas Marketplace: metal tiers, narrow networks, and how to read a plan you have no way to test drive before you buy it.
- CHIP and Children's Medicaid in Texas: The Age Bands That Decide Which One
May 12, 2026
Children's Medicaid runs to 198% FPL for infants and CHIP to 201%. How HHSC's age bands decide which of the two programs a Texas household lands in.
- Medicaid for Pregnant Women in Texas: The Limit, the Coverage, the 12 Months
May 11, 2026
Medicaid for Pregnant Women reaches 198% FPL on HHSC's chart, and coverage runs 12 months after the birth. What the pathway covers and how to apply.
- Texas Medicaid Eligibility: The Categories That Exist, and the Ones That Do Not
May 5, 2026
Category first, income second: how Texas Medicaid eligibility really works, the limits HHSC publishes, and the adult pathway this state never created.
- Why Texas Did Not Expand Medicaid: The History, and What Expansion Would Change
April 21, 2026
Ten states have not adopted the ACA Medicaid expansion and Texas is one. The policy history without a side, and what expansion would actually change here.
- The Texas Coverage Gap: Why Reapplying With the Same Income Changes Nothing
April 15, 2026
Too much for Medicaid, too little for a subsidy: about 605,000 Texans sit in the coverage gap, and reapplying next year with the same income changes nothing.
- Health Coverage in Texas: Every Route In, and Who Falls Between Them
April 13, 2026
Texas has the highest uninsured rate in the country at 16.7%. Every route to coverage here, who each one is for, and who none of them reach.
Texas Programs and Who Qualifies
- Children with Special Health Care Needs: The CSHCN Services Program in Texas
June 26, 2026
The CSHCN Services Program, the waiting list question nobody answers straight, and what a Texas family should ask before counting on it for a child.
- Texas Health Programs: The Full State List and Who Each One Is For
June 23, 2026
Beyond Medicaid and CHIP, Texas runs a scattered list of health programs. Who each one is for, what HHSC publishes as its limit, and which to try first.
- Kidney Health Care Program: The Texas Program for End Stage Renal Disease
June 22, 2026
The state program for Texans with end stage renal disease: what it is, where it sits against Medicare and Medicaid, and which office holds the criteria.
- Appealing a Denial in Texas: The Fair Hearing and Its 90 Day Clock
June 17, 2026
Ninety days from the effective date of the action, orally or in writing. What a Texas fair hearing can fix, what it cannot, and why late is worth asking.
- Breast and Cervical Cancer Services in Texas: Screening, Diagnosis, Medicaid
June 12, 2026
Screening and diagnosis through the state program, and the Medicaid pathway a cancer diagnosis can open in Texas when nothing else would take the patient.
- Texas Health Steps: What a Child on Texas Medicaid Is Entitled To
June 5, 2026
Texas Health Steps is the state's name for EPSDT: checkups, dental, and case management that come with a child's Medicaid enrollment rather than a new form.
- What Counts as Income in Texas: MAGI, Household, and the Wrong Denials
June 4, 2026
MAGI, household composition, and self-employment: the counting errors behind a large share of wrong Texas denials, and how to check the figure yourself.
- CHIP Perinatal: Coverage for a Pregnancy the Other Pathways Do Not Reach
May 19, 2026
CHIP Perinatal reaches 202% FPL and covers the pregnancy itself. The postpartum window is 60 days and two visits, not the 12 months people have read about.
- Healthy Texas Women: The Highest Published Limit on the HHSC Chart
April 28, 2026
204.2% of the federal poverty level is the highest published limit of any program on HHSC's chart. Who Healthy Texas Women covers, and what it does not.
- County Indigent Health Care in Texas: Chapter 61, County by County
April 22, 2026
Every Texas county runs one, the statutory floor is 21% FPL, and the answer is county by county. What chapter 61 requires, including three drugs a month.
- Applying Through YourTexasBenefits: The Account, Documents, and Timelines
April 18, 2026
One HHSC application is screened against several programs. The account, the documents, the interview, the timelines, and who is free to help you file it.
Care Without Coverage
- Care Across the Border: What Uninsured Texans Do, and How to Judge It
June 29, 2026
Border pharmacies, dental work, and the operation nobody can afford at home. What uninsured Americans actually do, and the follow-up problem they plan least.
- Care and Immigration Status in Texas: What Is Available Regardless
June 2, 2026
EMTALA applies regardless of status, and federally funded health centers serve everyone. What asks about status, what does not, and what we never record.
- Cash Prices and Self-Pay Discounts: Ask Before the Service, Not After
June 1, 2026
The self-pay rate is frequently below the billed charge, and uninsured patients hold a good faith estimate right under federal law that almost nobody uses.
- Mental Health Care Without Insurance: Texas Local Authorities and 988
May 28, 2026
Thirty-seven local mental health authorities and two behavioral health authorities, each with a 24/7 referral line. What they charge is the unpublished part.
- Dental Care Without Insurance in Texas: Health Centers and Dental Schools
May 25, 2026
An emergency room can treat the pain and the infection but will not fix the tooth. Health center dental, four Texas dental school clinics, and the time trade.
- Insulin Without Insurance in Texas: Do Not Ration, and the Routes That Exist
May 20, 2026
Rationing insulin is the fastest route to a hospital admission. The layers an uninsured Texan can work, and why this page publishes no manufacturer cap figure.
- Patient Assistance Programs: Manufacturer Help and the Paperwork It Takes
May 18, 2026
Most large drug manufacturers run one, each with its own income rules and its own form. Where to search, what the application asks, and who signs which part.
- Prescriptions Without Insurance: Working a Texas Price Down, In Order
May 15, 2026
Generics, the health center pharmacy, cash price shopping, and the three drugs a month a Texas county must pay for. The order to work a prescription in.
- EMTALA and the Emergency Room: The Right to Be Seen, and the Bill After
May 11, 2026
Screening and stabilization regardless of ability to pay, in force since 1986. The three things EMTALA is not, and why the bill afterwards still shocks people.
- Urgent Care Against the Emergency Room: Choosing Under Pressure in Texas
May 8, 2026
Which door to use when you are uninsured and something is wrong tonight: what urgent care cannot handle, what EMTALA covers, and what each bill looks like.
- How the Sliding Scale Works: The Federal Discount Schedule, Tier by Tier
May 3, 2026
Full discount at or below 100% of the poverty guidelines, three pay classes to 200%, nothing above. What the discount covers, and the bills it does not.
- Free and Charitable Clinics: Their Own Rules, and a Higher Income Ceiling
April 30, 2026
Volunteer staffed, narrower hours, and typically serving 100% to 300% of the poverty level. The clinic worth trying when a health center has said no.
- Getting Care Without Insurance in Texas: Where to Actually Be Seen
April 27, 2026
No program will take you? Here is the map of what exists anyway: health centers, free clinics, sliding scales, and what a front desk really asks you to bring.
- Community Health Centers in Texas: What They Must Charge, and How to Register
April 24, 2026
Texas had 71 federally funded health center organizations serving 1,859,052 patients in 2024. What they must charge you, and how to get on the books first.
Bills and What To Do About Them
- Payment Plans and What to Avoid: Sign Last, and Read What You Sign
July 24, 2026
Agreeing a plan acknowledges that the full amount is owed, which is why it comes last. Hospital plans against medical credit cards, and deferred interest.
- Complaining to the Texas Department of Insurance: Filing So It Lands
July 21, 2026
TDI can act on the plans it regulates and on nothing else. Establish that first, then file with the dates, the documents, and the rule you say was broken.
- Ambulance Bills in Texas: Ground or Air, the Card, and Then the Date
July 15, 2026
Three questions in order decide this bill. Texas bans balance billing for ground ambulance trips from 1 January 2024 on plans that TDI regulates.
- Hospital Price Transparency: The Files Hospitals Publish, and Using Them
July 13, 2026
Since 1 January 2021 every US hospital must post its prices online. Where the machine-readable file sits, and how to use it before a planned procedure.
- Medical Bill Collections in Texas: What Is Still Open After the Handoff
July 6, 2026
An account with a collection agency is not a settled account, and the hospital's charity care window often outlives the handoff. What to send, and to whom.
- Medical Debt and Your Credit: The Federal Rule That Never Took Effect
July 6, 2026
A CFPB rule published on 14 January 2025 would have stripped medical debt from credit reports. A court vacated it on 11 July 2025, so it can still appear.
- Negotiating a Hospital Bill in Texas: Who to Ask, and What to Put in Writing
June 26, 2026
Negotiation is step four, not step one. Who in a billing office can actually decide, what to ask for by name, and what a realistic outcome looks like.
- Texas Balance Billing Law: Does the Card Say DOI or TDI?
June 18, 2026
SB 1264 bans out-of-network balance billing for services from 1 January 2020, but only on plans TDI regulates. The card test decides which law reaches you.
- The No Surprises Act: What It Bans, and the Gap Texas Law Fills
June 15, 2026
In force since 2022 for most emergency care, out-of-network providers at network facilities, and air ambulance. Ground ambulance is where Texas law takes over.
- Reading an Itemized Bill: Requesting It, and What to Challenge First
June 8, 2026
The statement you were mailed is a summary, and the errors live underneath it. How to request the itemized bill in writing and rank what to challenge.
- Hospital Charity Care in Texas: The Application Window Is a Floor
June 5, 2026
Apply even if the account is already in collections. Section 501(r) sets a floor of 240 days, and Texas chapter 311 gives hospitals three standards, not one.
- Medical Bills in Texas: The Order of Operations From First Statement to Closed Account
June 3, 2026
Order of operations for a Texas hospital bill: itemized statement first, charity care before any payment plan, and the deadlines that are floors, not cut-offs.