Government-Funded Health Coverage

Medicare. Medicare is the Federal health insurance program for Americans age 65 and older and for certain disabled Americans. If you are eligible for Social Security or Railroad Retirement benefits and are age 65, you and your spouse automatically qualify for Medicare.

Medicare offers several different types of benefits:

The original Medicare Part A benefit is free for virtually all beneficiaries, and provides coverage for inpatient hospital stays.
Part B is optional coverage that pays for doctor's visits and outpatient hospital care, as well as some costs associated with physical therapy and home health care. Beneficiaries are charged a premium for Part B.
Part C is Medicare Advantage, formerly known as Medicare + Choice. Medicare Advantage is very much like a private health insurance plan, offering managed care, PPO, and fee-for-service coverage options. It is only available in certain regions of the country, and the premium is higher than that charged for Part B, but it does offer the convenience of packaging Part A, Part B, and additional coverage into one neat bundle.
Part D is Medicare's new Prescription Drug plan. Medicare contracted with private prescription drug plans to offer this benefit. Coverage for Part D began January 1, 2006.

Medicaid. Medicaid provides health care coverage for some low-income people who cannot afford it. This includes people who are eligible because they are aged, blind, or disabled or certain people in families with dependent children. Although it is federally funded, each state operates its own Medicaid program. People who are eligible for Medicaid in one state may not be in another.

State high-risk pools. In most states you can be turned down for individual coverage if you have a very serious medical condition (e.g., HIV or cancer). Fortunately, even though they are not required to do so, most states have developed some way to provide uninsurable people with access to individual health insurance coverage. Thirty-three states provide coverage to medically uninsurable people through high-risk pools. Twelve states use other means of providing uninsurable people with access to individual coverage (e.g., requiring that all individual health insurance companies issue individual policies regardless of health status, coverage through a designated health insurance company of last resort, etc.). There are five states that still have no means of providing individual health insurance access to people with catastrophic medical conditions. To find out what your state's options are for medically uninsurable individuals, check out NAHU's Health Care Coverage Options Database.

High-risk pools cost more than individual coverage, but for someone who cannot get health insurance any other way, they can be helpful.