Government Health Insurance through Social Insurance Programs

Medicaid

Medicaid is a state and federal program that provides health coverage to certain low income individuals and families who fit into an eligibility group that is recognized by federal and state law. Other qualifiers are also taken into consideration such as citizenship or lawful presence, pregnancy and disability.  Members receive free or low cost medical services through Medicaid providers. Some higher income individuals can also qualify for Medicaid at a higher out of pocket cost and are subject to spend-down rules. Medicaid provides the Essential Health Benefits  notated in the Affordable Care Act and also offers other benefits like nursing home care and personal care services. Enrollment in Medicaid satisfies the law to have health insurance or Minimum Essential Coverage (MEC).

You can apply for Medicaid in one of two ways:

• Through the Federal Marketplace

• Your State Medicaid Agency

Medicare

Medicare is the federal health insurance program in the U.S. for persons 65 and older. It also includes younger people with certain disabilities and people of any age with end stage renal disease. You must meet certain requirements to enroll in Medicare such as having worked at least 10 years in Medicare-covered employment. To determine your eligibility and or calculate your premium, you can check Medicare’s eligibility and premium calculator. Medicare counts as Minimum Essential Coverage (MEC) and satisfies the law that requires you to have health insurance. Generally, it consists of 2 parts: Part A and B. 

• Part A

(Hospital Insurance) helps cover inpatient (in hospital) care, skilled nursing facilities, hospice care and home health care. Usually, Part A is free (has no premium cost) if you or your spouse paid Medicare taxes while working. If you don’t meet the requirements for premium-free Part A, you may be able to buy it with a premium cost.

• Part B

(Medical Insurance) helps cover services from doctors and other providers (outpatient care), home health care, durable medical equipment, and some preventative services. For most people, there is a standard monthly premium for Part B.

Some people who qualify for Medicare may also qualify for Medicaid. People who qualify for both are known as “dual eligibles”.

There are many other components to Medicare such as deductibles, co-insurance, time sensitive enrollment dates, advantage plans, drug coverage, and supplemental plans, so it is advisable to be well informed when considering your options.  Free counseling about Medicare is available at State Health Insurance Assistance Programs (SHIP).  You can also visit the U.S. official government site for Medicare or call 1-800-MEDICARE (1-800-633-4227) for more information.