Commercial Payers

  • Information and updates on commercial health plans, helpful grids and tables for your practice (health plan contacts, behavioral health, efficiency and quality products by managed care companies, search for physician by languages spoken, Web portal systems, etc.), medical tourism guidelines, physician rating/ranking by health plans, prompt payment, silent PPOs and rental networks, Texas Department of Insurance links, Texas Medical Association resources and contract evaluation assistance, Tricare, links to Houston-area health plans, IPAs and PPO networks, and more.

 Health Insurance Marketplace 

  • The Affordable Care Act (ACA) requires individuals to have health insurance by 2014. Each state had the option of creating a state marketplace or participating in the federal marketplace. On July 9th, 2012, Governor Rick Perry announced that Texas would not implement a state exchange. Therefore, Texas will participate in the federal marketplace. The marketplace is scheduled to open on Oct 1st, 2014. Please refer to the Health Insurance Marketplace to learn more or to locate additional resources on the subject matter.

Medicaid and CHIP    

  • Medicaid is the State and Federal cooperative venture that provides medical coverage to eligible needy persons. The purpose of Medicaid in Texas is to improve the health of people in Texas who might otherwise go without medical care for themselves and their children. Please refer to HCMS' Medicaid website to learn more and/or locate additional resources on the topic.
  • Children's Health Insurance Program (CHIP) provides low cost health insurance or free healthcare coverage to eligible families.These healthcare services are managed by private managed care plans and each plan maintains its own network of physicians/providers.

 Medicare 

  •  The Medicare program was signed into law on July 30, 1965. This program is designed to provide healthcare coverage for: people age 65 or older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). The Medicare program has three components: Part A for hospital coverage, Part B for physicians services and outpatient care, and Part D coverage, which covers prescription benefits.

Medicare Advantage Plan (MAP) 

  • MAPs are plans offered by private companies that provide Part A, Part B and Part D coverage. These plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. This page contains information on where Medicare Advantage complaints can be filed as well as information on the sequester cut.

Medicare and Medicaid (Dual Eligible)

  • This section contains information on dual eligible patients.

Narrow Networks Complaints

  • TMA has drafted a TDI complaint letter which can be customized for your patients. Available in English and Spanish, this TMA resource makes it possible for patients to easily file a complaint with the Texas Department of Insurance (TDI) about a health plan's network.