Medicare, Medicaid, and state high risk pools
Government-funded Health Coverage
1. Medicare
Medicare is a government program that provides health coverage for people over 65, as well as people with certain disabilities that prevent them from working. 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 is in the process of contracting with private prescription drug plans to offer this benefit. Enrollment for Part D will begin on November 15, 2005, and coverage will take effect on January 1, 2006.
For more information about Medicare, see www.medicare.gov. This is the official informational website that the Centers for Medicare and Medicaid Services have set up for consumers with questions about Medicare.
2. Medicaid
Medicaid is another government program that is primarily geared towards low-income families with 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.
For more information about your state's Medicaid program, go to the Medicaid Consumer Page on the Centers for Medicare and Medicaid Services website and select your state.
3. State High Risk Pools
Thirty states operate high risk pools that offer coverage to individuals who have health conditions that prevent them from obtaining health coverage through a private insurer. High risk pools cost more than individual coverage, but for someone who cannot get health insurance any other way, they can be helpful.
The National Association of Health Underwriters just launched a website with information about state high risk pools. Go here to find out whether your state has one, and to get more information about how high risk pools operate.
