FAQs

General

Who or what is TMCP?

Texas Medical Care Plans is an agency dedicated and focused on helping our community make informed decisions about their health insurance, both Medicare and Obamacare.

If you have health insurance and have questions about your coverage, or if you don’t yet have health insurance and would like to get free or low-cost health insurance, contact us for help.

What is health insurance?

You may have been wondering what a health insurance is and what it means to have one. Health insurance is an agreement between the insurance company or “carrier” and an individual or company. This type of insurance helps people protect themselves financially against high medical costs, such as in the event of an accident, while also having a better quality of life with better medical care.

What is the deductible?

In the world of health insurances, it is very common to hear the term “deductible,” which is a bit confusing. The deductible is the amount of money that you, as the insured/client, agrees to pay before the insurance begins to pay your medical expenses.

For example, if you have a deductible of $3,500 and, unfortunately, you have a car accident whose medical expenses are $57,000 dollars, the average in the United States, it means that you as the insured have to pay $3,500 dollars before the insurance covers the remaining costs. In this case, the insurance would potentially protect you from paying more than $53,000 unless your policy has other limitations.

What is the copay?

Another common term you’ll hear when looking for health insurance is copay. The copay is the amount of money that you, as a patient, must pay each time you request medical services. The average cost of a visit to the family doctor in the United States in 2016 was $265. This means that if you visit your family doctor for a cold or other illness, you’ll be asked to pay that $35 for the visit, and your insurance will potentially pay the rest.

Why have health insurance?

According to a study by The American Journal of Medicine, 67% of bankruptcies are due to medical expenses. An unexpected visit to the emergency room, due to an accident, illness such as bronchitis or unexpected situations such as abdominal pain, costs an average of $3,000.

Having health insurance protects, not only you as a client, but also your family, from not being part of the bankruptcy statistics and to have peace of mind in case of an unexpected situation. This is without counting the costs of more severe or recurring diseases such as cancer, diabetes, kidney failure, etc.

These are just a few of the many reasons why having health insurance makes a lot of sense. The best part is that most people qualify for a government subsidy, making health insurance free or very low cost depending on your personal situation.

Who qualifies for health insurance? (Obamacare and Medicare)

In general, all people who have a legal status, such as citizens, residents, people with work or student visas can have access to health insurance.

What is the difference between Obamacare and Medicare?

Obamacare or The Affordable Care Act (ACA for its acronym in English), is a set of laws for access to health insurance until before the age of 64, in general. Among many other things, Obamacare specifies a subsidy or discount from the federal government to make health insurance more accessible to the general public.

Medicare, on the other hand, is insurance provided by the federal government, through private companies, for people over 65 years of age or who have been receiving social security disability benefits for more than 2 years.

Where and how can I get health insurance? (Obamacare and Medicare)

At Texas Medical Care Plans, we’re happy to help you get both Obamacare and Medicare, depending on your situation.

Which health insurance is better? Which one is for me?

All plans are good, but the interesting thing is to find the best plan according to both medical and economic needs.

What health insurance do I have?

All plans are good, but the interesting thing is to find the best plan according to both medical and economic needs.

What health insurance has coverage for COVID-19?

All Obamacare plans offer COVID coverage.

What medical insurance covers the psychologist?

All plans offer mental health care.

What is the cheapest insurance?

The vast majority of people qualify for $0 per month plans. 4 out of 5 people can get a plan for $10 or less per month. But this depends on 5 factors: income, family size, ages, city and type of coverage you are looking for.

Obamacare

What is Obamacare?

The Affordable Care Act or popularly known as Obamacare, is a set of laws that were a fundamental part of President Obama’s campaign. And although they were a point of much debate and controversy when they were announced, they are now a part of our lives.

This Health reform, whose objective was to make medical insurance accessible and affordable for all, is still in force, although it has changed a little over the years and the different administrations. But basically they grant the benefit of having health insurance until the age of 65.

Among the benefits of Obamacare are: emergency room services, hospital, maternity, doctor and laboratory services, mental health and substance abuse services, rehabilitation, preventive services, pediatric services, among others.

How much is it?

The cost of health insurance depends on many things, such as the amount you want to pay in copay, deductible, and your personal and family financial situation. However, most people qualify for health insurance at no monthly cost.

To find out how much insurance would cost for you or your family, contact us so we can give you a quote without obligation.

How does it work?

Most people qualify for subsidies which help lower or eliminate medical costs.

How do I enroll?

The easiest way is to contact us to help you enroll in the right Plan for your needs.

What is the deductible in Obamacare?

The deductible can vary depending on many factors, but there are currently quite a few options on the market where the deductible is $0.

Obamacare vs Private Insurance

Obamacare are private insurance where you can get a subsidy to pay the monthly premium or you can pay the full cost like any other private insurance.

What are the most recommended Obamacare plans?

All plans and companies are good, but there will always be an option that best suits your health and financial needs.

Questions about my Obamacare plan

My card has not arrived, what do I do?

  1. Access the company portal and create an account to obtain a virtual
  2. Call your insurance company
  3. Contact our office at (915) 781-1614. One of our agents will help you.

How do I make a payment?

  1. Access your plan’s payment link and enter all the policy information
  2. Call your insurance company to make a payment
  3. Contact our office at (915) 781-1614. One of our agents will help you.

Who is my primary doctor? How do I assign it?

  1. Check on your plan’s website or app
  2. Call your insurance company to ask them
  3. Contact our office at (915) 781-1614. One of our agents will help you.

What doctors / hospitals / pharmacies can I visit?

  1. Check on your plan’s website or app
  2. Call your insurance company to ask them
  3. Contact our office at (915) 781-1614. One of our agents will help you.

How much will I pay for my medical consultations/services?

It all depends on the benefits of your plan. We recommend reviewing the following on your plan page or app:

  1. Summary of benefits
  2. Check on your insurance company’s website/app
  3. Call your insurance company
  4. Contact our office at (915) 781-1614

Medicare

What is Medicare?

It is the federal health insurance program for people 65 years of age or older, for people who have been receiving disability benefits through social security for more than 2 years, and people with end-stage renal disease.

How does it work?

The beneficiary usually receives his Medicare card 3 months in advance of the effective date and it is identified as a white cardboard card with a red and blue stripe that commonly includes part A and part B. The beneficiary is responsible for seeking additional or supplemental coverage.

What are Medicare Parts A, B, C, and D?

Part A is access to Hospital coverage and Part B to Doctors, Part D helps cover the cost of prescription drugs and the famous Part C, which are the Medicare Advantage Plans that combine Hospital, Doctors, Medications and other benefits such as Dentist, Glasses, Hearing Aids, Transportation, Non-Prescription Medications, among other benefits.

How much does it cost?

For most, Medicare currently costs $170.20 per month. But there are quite a few people for whom this cost is currently covered by the state or reduced by certain Medicare Advantage Plans.

How do I enroll in Medicare?

Most people must enroll in Medicare at age 65. You can contact us and we will help you sign up.