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Government Programs As They Apply to Health Care

What government programs offer health-care benefits?

In some cases, you may be able to get health-care coverage through a government program. The three primary government programs that offer health care benefits are Medicare, Medicaid, and the Department of Veterans Affairs (VA, formerly the Veterans Administration). Many states also offer additional programs.

 

Medicare is a federal health insurance program that primarily assists individuals who are 65 or older. If you are disabled or have kidney disease, you may be eligible for Medicare coverage, no matter what your age. Medicaid is a health insurance program that is jointly administered by state and federal governments. Medicaid serves needy individuals who are also elderly, disabled, blind, or parents of minor children. Active military servicemembers and veterans are eligible for health care through the VA.

The Patient Protection and Affordable Care Act of 2010 includes several provisions related to Medicare and Medicaid. Medicare Part D drug coverage and Medicare Advantage plans are affected while coverage of prevention benefits is expanded for traditional Medicare. Medicaid coverage is expanded to provide insurance coverage for low-income individuals.

Medicare

What does Medicare cover?

Currently, Medicare consists of four parts: Part A, Part B, Part C, and Part D. Medicare Part A, generally called "hospital insurance," covers services associated with inpatient care in a hospital, skilled nursing facility, or psychiatric hospital. Medicare Part B, generally called "medical insurance," covers other medical care such as ambulance service, lab tests, and physical therapy. Medicare Part C permits Medicare beneficiaries to receive health care through managed care plans such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and others. Medicare Part D covers the costs of prescription drugs.

Who is eligible for Medicare?

Medicare was enacted into law to provide reasonably priced health insurance for retired individuals, regardless of their medical condition. Most people become eligible for Medicare upon reaching age 65 and becoming eligible for Social Security retirement benefits. In addition, some disabled individuals and individuals with end-stage renal disease are also eligible for Medicare coverage.

Medicaid

What does Medicaid cover?

Each state administers its own Medicaid program, within broad federal guidelines. Thus, the states determine the amount, duration, and types of benefits Medicaid will provide. Typical Medicaid programs cover inpatient and outpatient hospital services, physician and surgical services, lab tests and X rays, family planning services, and prenatal and delivery services for pregnant women. There are also numerous optional benefits that states may choose to provide for Medicaid recipients.

Who is eligible for Medicaid?

States also set their own Medicaid eligibility standards, within broad federal guidelines. Typically, states require Medicaid applicants to meet two basic eligibility requirements. First, they must be "categorically" needy because of blindness, disability, old age, or by virtue of being the parent of a minor child. Second, the individual must be financially needy, which is determined by income and asset limitation tests.

Military benefits (VA)

What military health-care benefits are available?

Disability benefits, health care benefits, and long-term-care benefits are available through various military programs sponsored by the Department of Defense (DOD) and the Department of Veterans Affairs (VA). Health care for veterans is typically available at VA hospitals and health-care facilities.

Who is eligible for military health-care benefits?

In general, active servicemembers, retirees, and veterans other than those who were dishonorably discharged are eligible for military benefits. Survivors of servicemembers and veterans are also eligible for some of the same benefits. However, the rules surrounding these benefits can be complex and may change frequently. Check with your military personnel office or local VA office if you have questions about any of these benefits.

 

 

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Published in Medicare Basics