Government-Funded Health Plans
The federal government funds a wide range of medical services through its own programs, and in partnership with states as well as private insurers.
Medicare covers a wide range of health care services and drug benefits for people 65 years and older. It also covers certain younger people with disabilities and those with permanent kidney failure requiring dialysis or a transplant. You will pay premiums and out-of-pocket costs but they will be much lower than any commercial plan. If you continue to work after age 65, you can combine Medicare coverage with other types of commercial coverage.
There are several Medicare terms. Here is what they mean.
Sometimes called Traditional Medicare or Fee-for-Service Medicare, the government pays directly for the health care services you receive. You can see any doctor and hospital that takes Medicare (and most do) anywhere in the country.
This is included in Original Medicare and covers inpatient hospital care, skilled nursing facility care, hospice, lab tests, surgery and home health care.
This is included in Original Medicare and covers doctor and other health care providers' services (such as provider provider-administered infusions), outpatient care, durable medical equipment, home health care and some preventive services.
Also called Medicare Advantage, these plans are managed by a private insurer. Your health care ID card will have a logo from United Healthcare or Aetna, for example. If you have a Medicare Advantage Plan, you still have Medicare. You'll get your Medicare Parts A and B coverage from the Medicare Advantage Plan, not from Original Medicare. These plans are similar to HMO and PPO plans but premiums and costs are much lower than commercial plans because the government decides how much providers can charge.
This is the drug benefit plan provided by Medicare. You have to sign up for Medicare Part D unless you choose a Medicare Part C plan that includes prescription drug coverage.
Private companies sell Medicare Supplement Insurance (Medigap) policies. It helps to pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance and deductibles, or medical care when you travel overseas.
Medicaid (*may have an alternate name in your state)
Medicaid is jointly run by the federal government and state governments. It helps low-income individuals, children, their parents, the elderly and people with disabilities. Eligibility for Medicaid benefits varies widely among the states - all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guidelines.
The program also covers some benefits not covered by Medicare, like nursing home care and personal care services. Although medication coverage is an optional benefit under federal Medicaid law, all states cover outpatient prescription drugs within their state Medicaid programs.
Six states (Arkansas, Iowa, Michigan, Indiana, New Hampshire and Montana) are currently implementing or planning to implement Medicaid expansion as per the Affordable Care Act income provision and provide benefits to all Americans under age 65 whose family income is at or below 138 percent of the federal poverty guideline. Find out if your state also plans to expand Medicaid coverage.
Children’s Health Insurance Plan (CHIP)
CHIP provides low-cost health coverage to children in families that don’t qualify for Medicaid, as well as pregnant women in certain states. Although this is a federal program, each state provides CHIP coverage and works closely with its state Medicaid program. Although benefits are different in each state, CHIP generally covers:
- Routine check-ups
- Doctor visits
- Prescription drugs
- Dental and vision care
- Inpatient and outpatient hospital care
- Laboratory and X-ray services
- Emergency services
TRICARE Military Plan
This health care program is managed by the United States Department of Defense Military Health System. It covers uniformed service members, both active duty and retired members of all branches of the armed services.