Learn About 5 Government Health Care Programs

Learn About 5 Government Health Care Programs

Although the United States is one of the highest-income nations in the world, quality health care is still not accessible to each and every citizen, as it is in most other high income nations. But despite the fact that the U.S. does not have universal health care, the country offers several government health insurance programs to provide free or low-cost health care to groups like lower-income Americans, children, veterans, military service members, people with disabilities and the elderly.

The Affordable Care Act (ACA), commonly known as Obamacare, was the largest overhaul of the health care system in the US since 1965, when Medicare and Medicaid were introduced. The ACA was signed into law by President Barack Obama in 2010. The ACA is still in effect, despite ongoing efforts to repeal it. Some of the ACA’s provisions have helped more people get access to free or low-cost health insurance.

If you do not get health insurance through an employer or cannot afford to buy a private insurance plan, consider the following government health care programs. Each program has its own unique eligibility rules.

1. Medicaid

Signed into law together with Medicare in 1965, Medicaid is a federal health care program administered by each state. 

The program is aimed at helping U.S. citizens and qualified non-citizens with low income and insufficient financial resources to purchase a health care plan. Medicaid provides health coverage for low-income adults and their children, as well as individuals with disabilities and pregnant women..

In 2014, the ACA expanded Medicaid eligibility to adults with incomes below 133 percent of the federal poverty level (FPL). However, the expansion is optional for states, and some states have chosen not to enact the Medicaid expansion.

In 2019, 19.8 percent of the US population benefited from Medicaid coverage. Beginning in 2020, Medicaid health coverage for newly eligible individuals is 90 percent-funded by the government at the federal level, with the state funding the other 10 percent. 

All 50 states, the US territories and the District of Columbia have Medicaid programs in place, but each state has its own set of Medicaid eligibility criteria, specific health care services covered by their program and reimbursement processes for health care providers. Mandatory federal benefits include inpatient and outpatient hospital services, nursing facility services, physician services, transportation to medical care and home health services, among other services. 

Medicaid state programs include Medi-Cal in California, Apple Health in Washington, Oregon Health Plan in Oregon and more. 

2. The Children’s Health Insurance Program (CHIP)

Signed into law in 1997, CHIP is a health care program, which, like Medicaid, is administered by individual states. Both the state and the federal government fund the program. CHIP is specifically designed to cover the medical costs of uninsured children in low-income families that still have too much income to qualify for Medicaid. CHIP helps these children from families that are unable to afford private health insurance.

Eligible children and pregnant women can benefit from health coverage through separate CHIP insurance plans and Medicaid alike. In addition to their families’ incomes, CHIP eligibility criteria also include state residency, immigration status and citizenship. 

The Children’s Health Insurance Program is administered by the federal Centers For Medicare and Medicaid Services, and states are given the flexibility to design their own CHIP programs according to some federal guidelines. The eligibility standards vary from state to state, and they can range from 170 percent of the FPL to as high as 400 percent of the FPL. 

Mandatory CHIP benefits include well-baby and well-child visits, vaccines, behavioral health benefits and dental benefits. States can choose to implement CHIP enrollment strategies such as continuous eligibility, express lane eligibility and presumptive eligibility. These are various ways to determine eligibility.  

3. Medicare

Medicare is a government health insurance program focused on providing health care coverage for the elderly population (65 years of age or older). It also provides coverage for people with disabilities who qualify for disability benefits and people with preexisting conditions such as Lou Gehrig’s disease and end-stage renal disease. 

Eligible individuals can sign up for Medicare coverage depending on their needs. Medicare health coverage consists of four parts: Part A, Part B, Part C and Part D. Medicare Part A provides health coverage for inpatient hospital services, surgery, lab tests, nursing facility services, home health care and hospice. 

Medicare Part B (or Medical insurance) covers not only physician and health care providers’ services but also durable medical equipment and many preventative & screening services. 

Medicare Part C, also known as the Medicare Advantage Plan, is an option to get Medicare through a private health insurance company. Beneficiaries who opt for Medicare Part C will have Parts A and B, and may get additional benefits like vision and dental coverage. These plans may also offer Part D. Medicare Part D covers prescription drug plans. 

It’s worth noting that some Americans qualify for both Medicare and Medicaid, which makes them dual-eligible. 

4. Tricare

Tricare offers a range of health care plans to two categories of beneficiaries: sponsors (including active duty, Guard/Reserve and retired members) and family members (spouses and children registered in the Defense Enrollment Eligibility Reporting System [DEERS]).

Tricare health plans include Tricare Prime/Prime Remote/Prime Overseas, Tricare For Life, Tricare Select/Select Overseas and Tricare Reserve Select (for sponsors), as well as  Tricare Young Adult and The U.S. Family Health Plan (for family members).

Tricare coverage may include: 

  • Health care services that are medically necessary.
  • Dental care services (Tricare dental coverage is separate from its medical coverage).
  • Mental health care (both inpatient and outpatient care).
  • Vision care.
  • Special needs (under the basic Tricare benefit for those with special needs).
  • Prescription medication  (via the Tricare Pharmacy Program that manages prescriptions through Express Scripts).

5. VA Health Care

The Veterans Health Administration provides health coverage for veterans and their dependents while offering a range of tools and information aimed at connecting veterans to the health support services they need. Veterans enrolled in a VA health care program benefit from health coverage that meets the ACA’s coverage standards, so they do not need to take further steps for health care.

Veterans who have still not enrolled in a VA health care program can do so at any time, by filling out Veterans Affairs (VA) Form 10-10EZ. The minimum duty requirements are determined by the Veterans Affairs program. Eligibility for VA health care benefits includes the applicant’s income and specific priority group. Priority groups include those with service-connected disabilities / medical conditions, Purple Heart recipients and retired service members. The vast majority of veterans have no out-of-pocket costs.

Standard benefits include: 

  • Preventive care and screening services.
  • Inpatient and outpatient health care services (for example, medical, surgical dialysis, substance abuse)
  • Mental health care services
  • Prescription drugs.