How to Choose the Right Government Health Coverage

From Medicare and CHIP insurance to Medicaid and military healthcare, the government offers a wide variety of subsidized coverage options for U.S. residents. Eligibility for these programs varies depending on basic factors such as age, income and medical status. In some cases, your state of residence and other factors may also play a part. For instance, the VA health care program offers different tiers of coverage based on an applicant’s service history and disability rating.

As the cost of health insurance increases, you may be interested in learning if you are eligible for Medicare benefits or other assistance. The federal government offers coverage for qualifying seniors, low-income children and adults, military members and veterans. The sections below go over the basics of the government health insurance programs available, including eligibility requirements, cost and the application process.

What is Medicare?

The Medicare program was created to provide health insurance for adults 65 years of age and older, and individuals of any age with certain medical conditions. Overall, Medicare benefits vary depending on which of the following plans an individual enrolls in:

  • Part A covers in-patient hospital and specialized nursing home services.
  • Part B provides supplementary coverage for preventative care, doctor’s visits, special exams, medical equipment and more.
  • Part D offers coverage for prescription drugs.
  • Part C offers Medicare patients the ability to receive healthcare through a private insurance company subsidized by the Medicare program.

Those who meet the right Medicaid eligibility requirements are automatically enrolled in Medicare Part A, and may be automatically enrolled in Part B when they turn 65 years of age. In some cases, automatic enrollment is not possible, so applicants must purchase the plan or plans they want. Specific rates for each plan may be determined based on income.

If you are not automatically enrolled in Medicare coverage, you can apply online, over the phone or in person at your local Social Security Office. The initial enrollment period is seven months after you turn 65, though in some cases you may be eligible for a special enrollment period.

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Did you know? You can use the online Medicare Plan Finder to start comparing local Medicare plans for free.
Did you know? You can use the online Medicare Plan Finder to start comparing local Medicare plans for free.
What is Medicaid?

Medicaid is designed to provide free or low-cost health insurance to low-income families, pregnant women and disabled individuals. In some states, it has been expanded to include able-bodied adults without children as well. Medicaid eligibility typically depends on a household’s income, and income requirements are set at the state level. If you exceed the income limits, you cannot receive coverage through Medicaid.

Medicaid benefits also vary from state to state. Some benefits are federally mandated, such as inpatient and outpatient hospital services, lab and x-ray services, physician services and family planning services. Others, such as physical therapy, prescription drug coverage and vision coverage, are optional and may not be covered by some states.

Unlike Medicare, you can generally apply for Medicaid coverage at any time of the year if you meet the eligibility requirements. The Medicaid application process varies from state to state, so you can learn how to apply by contacting your state’s Medicaid office. You can also apply by submitting an application through the Health Insurance Marketplace.

Learn About CHIP Insurance

The Children’s Health Insurance Program (CHIP) provides health insurance to children under 19 years of age. This program was created for families who make too much to qualify for standard Medicaid, but who cannot afford insurance for their children. CHIP will sometimes cover pregnant women through the duration of their pregnancy and for limited postnatal treatment as well.

In some states, Medicaid and CHIP may be combined into one program, while other states treat them as separate programs. As such, CHIP coverage varies from state to state. However, all states are required by the federal government to provide comprehensive treatment for children enrolled in the program. This includes:

  • Doctor visits.
  • Immunization.
  • Dental coverage.
  • Vision coverage.
  • Inpatient hospital treatment.
  • Outpatient hospital treatment.
  • Emergency services.

Treatment outside these requirements, such as mental health services, may not be included under CHIP in your policy. You must research the specific benefits available in your state to learn the treatments your child may receive through the program. Whether you begin the CHIP application process online or by phone, you will be connected to your state’s CHIP agency to determine if your child is eligible for coverage.

What is Tricare?

Tricare is a military health insurance offered to active service members and some members of the reserve, as well as their dependents. The program offers a wide variety of plans at an affordable price for soldiers. Under Tricare, active duty service members may pay nothing out of pocket for treatment, while other beneficiaries pay a discounted rate for services.

There are point-of-service plans, managed care plans, Medicare wrap-around plans and premium-based plans available for service members and their families. However, the details of the coverage depends on the plan purchased. Additionally, when someone completes their service, they may no longer be eligible for the same kind of coverage.

It is important to note that Tricare insurance does not provide coverage for all services. For instance, emergency contraception is not covered under Tricare plans, and dental treatment is usually not included either. A plan may also have deductibles and high co-pays in exchange for a lower premium.

You can submit your application for Tricare coverage online, over the phone or by mail with your regional contractor. The correct phone number to call or contractor to mail your application to varies by location.

What is VA healthcare?

The Department of Veterans Affairs (VA) offers some military health insurance coverage as well. Qualifying veterans typically receive fully subsidized coverage with few or no out-of-pocket expenses. Veterans enrolled in the program receive coverage for the following treatments:

  • Preventative treatment and primary care
  • Specialty physician care
  • Mental health services
  • Home health services and geriatric care
  • Prescription drug coverage
  • Medical equipment coverage

Coverage is not limited to what is listed above. However, not all veterans qualify for subsidized coverage under the program. Additionally, VA health care coverage is offered in tiers depending on your service history and your disability rating. If you have a mild disability or no disability, you may not be eligible for treatment.

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