Learn About Government Programs That Help With Medical Costs

If you have difficulty meeting your medical costs, you do not have to suffer without needed care or sacrificing other necessities to meet those needs.

The federal and state governments offer several programs to help you save money on medical costs. Some of these programs even cover certain health care products and services completely, depending on your eligibility. The most predominant and, perhaps, popularly known of these government programs is Medicaid. If you have children in your family, they may also qualify for the Children’s Health Insurance Program, or CHIP. If you fail to meet the qualifications for either of these programs yet have a significant medical need, you may be eligible for the Medically Needy program. Additionally, if you are disabled, you may be eligible for Social Security disability benefits.

You can apply for all government medical cost savings programs in a variety of ways, including in person, online or by mail or phone, depending on the program. Learn more about each of these programs below. For further assistance regarding any of these programs, contact your local Social Security Administration (SSA), state-specific Medicaid office or other agency representative for medical coverage. Beyond these options, your local health centers and state human service agencies may also offer other forms of assistance to folks with restrictive health care access or in the midst of medical distress. These agencies may also provide referrals to other organizations nearby that may have assistance to offer. Among the possible services they may offer are help paying for vaccinations and prescription medications.

What is Medicaid?

Managed by the Centers for Medicare and Medicaid Services (CMS), Medicaid provides assistance covering medical expenses for low-income recipients and other qualifying individuals. Medicaid is a federal program administered by the states. With this type of program, the states decide the rules, requirements and coverage options within limitations set by federal guidelines. Included in those federal guidelines are requirements that require the state to offer certain medical services and products. Other services are optional and left to each state to decide whether to cover.

To be eligible for Medicaid, you must meet certain income criteria and, possibly, depending on the state, other criteria as well that may include demographic information like your age and your health condition like pregnancy. Seniors and people with disabilities often qualify for Medicaid in many states. Regardless of your state, once each year, you must reapply for Medicaid and demonstrate you still qualify. Medicaid qualifies as a valid health insurance plan to meet Affordable Care Act (ACA) requirements. If you participate in a government health care program like Medicaid, then you do not need to purchase an additional health insurance marketplace plan, as the Medicaid coverage will meet ACA requirements.

Learn About CHIP

The Children’s Health Insurance Program (CHIP) provides assistance covering medical and dental expenses for children living in low-income households. A child’s qualifications for CHIP are based on the household’s income and, possibly, other criteria that vary between states. If your household qualifies for Medicaid, then chances are your child qualifies either for Medicaid or CHIP. If your household’s income is too high to qualify its adults for Medicaid, however, children in that household may still qualify for CHIP, as the income thresholds for the two programs usually differ.

In most states, a child may qualify for CHIP until he or she reaches 19 years of age. A qualifying relative or legal guardian or representative of the child may apply for CHIP on behalf of the child. As with adults on Medicaid, if your child participates in CHIP, he or she does not need any other marketplace insurance in order to meet Affordable Care Act requirements.

Find Out About the Medically Needy Program

Perhaps your household income is too high to qualify you for Medicaid or your child for Medicaid or CHIP yet you or your child has a serious medical need. In addition to serious illness, the qualifying factors for medical need may include pregnancy, disability or age, as youths and seniors often qualify. Many states have Medically Needy programs that make allowances for such circumstances. Under such a program, your medical expenses can be deducted from your income in order to reduce it enough to qualify you for Medicaid benefits. You must requalify for your state’s Medically Needy program each period, as determined by the state, and benefits attained in a particular period may only be utilized during that period. Fortunately, if you are enrolled in the program, the state will notify you in advance of that time.

About Social Security Disability Benefits

If you are disabled and you held jobs in the past with employers covered by Social Security, you may be eligible for Social Security disability benefits (also called Social Security Disability Insurance, or SSDI). Generally, Social Security pays qualifying individuals unable to work for at least a year due to a disability cash benefits to apply toward medical expenses. These benefits continue until you can work regularly again, and the program incorporates work incentives to help you achieve that objective. The amount of Social Security disability benefits you have earned in your work history depends on your total annual wages or income from self-employment. You earn credits for qualifying periods of work that, in turn, qualify you for some amount of SSDI benefits should you become disabled during that period. Work credits carry over between periods provided they are not utilized. If you stop work due to disability and use up work credits receiving SSDI benefits during that out-of-work period, you must earn new work credits when you resume work in order to be eligible for Social Security disability benefits should you become disabled again.

The SSA considers you disabled if you can no longer perform the work you were previously paid to perform and cannot adapt to perform other work due to medical issues. Further, your disability must be full and long-term to qualify you for SSDI. No short-term or partial disabilities qualify. Special circumstances may also qualify you for SSDI, such as if you are blind or have limited vision, are the widow or widower of the worker, a disabled child or a veteran or wounded warrior. SSDI is distinct from Supplemental Security Income (SSI) that pays cash benefits for regular, non-medical living expenses to people with disabilities and limited resources and income. Additionally, you could qualify for and receive both SSI and SSDI.

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