Commercial Payers

  • Information on reimbursement and medical policies, forms, appeals, etc. by payer. 

Health Insurance Marketplace 

  • The Affordable Care Act (ACA) requires individuals to have health insurance. Texas will participates in the federal marketplace. Please refer to the Health Insurance Marketplace to learn more or to locate additional resources on the marketplace.

Medicaid and CHIP    

  • Medicaid is the State (TMHP) and Federal cooperative venture that provides medical coverage to eligible needy people in Texas who might otherwise go without medical care for themselves and their children. Please refer to the Texas Medicaid website to learn more.
  • The 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 with their own network of 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, or people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease. The Medicare program has three components: Part A for hospital coverage, Part B for physicians services and outpatient care, and Part D coverage for 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 sequestration 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 inadequacy.