There are a number of government health insurance options for individuals and families. These programs are designed to make it easier for everyone to have access to some form of health care coverage regardless of age, disability or employment status. There are specific programs for veterans, women, children, the elderly, low-income families and those with disabilities.
Most people are familiar with Medicaid, Medicare and CHIP, but fewer people know the eligibility requirements or benefit coverage for programs like TRICARE and Medicare Advantage. The following sections will go over eligibility, benefits and plan features for the various government insurance alternatives.
Medicaid is a massive health insurance provider in America. It provides health coverage for low-income individuals and families. It covers people who have children, the elderly, people with disabilities, pregnant women and those who qualify for Supplemental Security Income (SSI). Medicaid eligibility guidelines may vary depending on your state, but there are also Federal guidelines to ensure that everyone who needs help has access.
Copayments and cost-sharing will depend on how much your state pays toward a given medical procedure or service. There are maximum and minimum percentages that Medicaid recipients can be charged. For example, Medicaid Managed Care Copayments are $4.00 or 20 percent of the amount the state pays. This makes it possible for most families and individuals to afford the out-of-pocket expenses of routine and emergency medical care.
For those with chronic conditions and the elderly, Medicaid offers Health Home. It is a plan that offers care management and coordination, comprehensive transitional care and follow-up, patient and family support and referrals to community resources to those who qualify. To be eligible for Health Home, one of the following criteria must be met:
- Have two or more chronic conditions
- Have one chronic condition and are at-risk for a second
- Have one serious mental health condition
The Children’s Health Insurance Program (CHIP) is available for low-income children. The goal of the program is to provide low-cost insurance to help cover children who live in low-income households. Low-income families who earn too much to qualify for Medicaid can often get coverage through CHIP. The state you live in will determine what the cut-off income level is for CHIP.
This program is known under various names, depending on where you live. For example, in Ohio, CHIP is called “Healthy Start.” You can find information on what it is called in your area by visiting your state’s health and family services website.
Routine medical and dental visits for children are covered under CHIP for free. However, some states may charge a monthly premium or charge a copayment for some services.
All states must provide the following medical benefits:
- Routine medical check-ups
- Doctor visits
- Regular dental and vision care
- In-patient and out-patient hospital care
- Laboratory and X-ray services
- Emergency services
Some states will cover additional health care services.
Medicare is health insurance for those who are aged 65 or older, individuals with End-Stage Renal Disease (ESRD), and anyone receiving Social Security Disability Insurance (SSDI). This federal program is designed to make it easier for people who might otherwise have a difficult time qualifying for insurance to get the coverage that they need. You can receive Medicare in addition to any employer health care insurance.
It is not always necessary to sign up for Medicare. If a person is receiving Social Security retirement benefits, he or she will automatically be enrolled when specific criteria are met..
There are several different components included in Medicare. These are Medicare Part A, Part B, Part C and Part D. Each one covers a specific service category such as medication or hospital services. Individuals can choose to use whichever parts they qualify for that work best for their health needs.
There are two primary types of plans: Original Medicare and Medicare Advantage. The main difference is that Original Medicare has plans covered by the federal government, while Medicare Advantage plans are provided by private health insurance companies. For both, there will be out-of-pocket costs for services. Original Medicare can be used at any doctor’s office in the country that accepts Medicare without needing to stick to a specific network.
To qualify for TRICARE, you must be either a current or retired service member. Survivors, former spouses, and their families are also covered. Eligibility includes being a member of one of the following groups.
- Army National Guard
- Army Reserve
- Navy Reserve
- Marine Corps Reserve
- Air National Guard
- Air Force Reserve
- U.S. Coast Guard Reserve
- Medal of Honor recipient
- Uniformed Service Member
You can get full out-patient, in-patient, emergency, prescription, prevention and medical supply coverage with various health care plans available through TRICARE. There is also a program called TRICARE For Life, which combines with Medicare Parts A and B. Automatic enrollment is in effect for those who qualify.
TRICARE also has some special programs for demographics that might require additional support, such as Autism Care, Cancer Clinical Trials, and Computer or Electronics Accommodations. There is also an Extended Care Health Option (ECHO) for families with special needs, which provides financial support and supplies for those who qualify.
Veterans’ Affairs (VA)
The Department of Veteran Affairs (VA) provides health care to military veterans through the VA Health Care program. Eligibility for VA health care services and any copayment amounts depend on details of your discharge, service-connected health problems and income level.
While all veterans accepted into a VA health care program have their medical services covered, some benefits like dental may not be available for everyone.
VA health plans cover the following medical services:
- Preventative care
- In-patient and out-patient services
- Emergency care
- Mental health services
- Prescriptions within the VA system
- Assisted living care
Some people may also be eligible for non-medical assistance, such as transportation and travel for procedures and caregiver support. Certain benefits, such as urgent care that is not life-threatening, may require that you have been on an active VA plan for 24 months. Vision and dental care will be determined by the plan details and are not always covered. You can use VA health care simultaneously with other plans provided by Medicare, Medicaid, and TRICARE for those that qualify.