How Healthy Texas Works
From the enrollees perspective, the Healthy Texas plan will operate like any private market plan. Healthy Texas is designed to reimburse carriers for 80 percent of the costs if an individual’s total claims fall between $5,000 and $75,000 in a calendar year. UnitedHealthcare will cover the rest. This allows the state to leverage public and private funds.
Annual Claims Costs
|$75,000+||UnitedHealthcare pays 100%|
|$5,000-$75,000||Healthy Texas pays 80% / UnitedHealthcare pays 20%|
|$0-$5,000||UnitedHealthcare pays 100% (after co-payment and deductible requirements are met)|
Enrollees receive the same type of benefits they’d receive from any private market plan, including: