Health Care Resources
If a free society cannot help the many who are poor, it cannot save the few who are rich.
~John Fitzgerald Kennedy
Good health is important to everyone; unfortunately, not everyone can afford adequate medical care when it’s needed. If you are uninsured or underinsured and need medical care now, yet cannot afford to pay for it, there may be a government program that can help you. Several health care options are currently available to qualifying, low-income individuals and families from either a federal or state agency to help you get healthy and stay healthy.
The Centers for Medicare & Medicaid Services (CMS)
The CMS is the federal agency responsible for administering the Medicare, Medicaid, State Children’s Health Insurance (SCHIP), Health Insurance Portability and Accountability Act (HIPAA), and other health-related programs. An overview of these programs is provided below, or you may visit their online site at http://www.cms.hhs.gov/ for additional information and how to apply for these benefits.
Medicare is a social insurance program administered and funded by the federal government. It provides health insurance primarily for people age 65 or older, but also for people under age 65 who meet certain health criteria, who are either a US citizen or have been a permanent legal resident for five continuous years.
- In 2007, Medicare provided health care coverage for 43 million Americans
The Medicare program is administered by the Centers for Medicare and Medicaid Services (CMS), however eligibility and processing of premium payments is handled by the Social Security Administration. CMS has contracted with various private companies to assist with the administration.
The Medicare program is categorized into parts: Part A – Hospital Insurance, Part B – Medical Insurance, Part C – Medicare Advantage Plan, and Part D – Prescription Drug Plan. Medicare does not cover all of a person’s medical costs – beneficiaries have premiums, deductibles, and co-pay amounts. Some low-income people may also qualify for dual coverage with a program such as Medicaid to help pay for premiums and other out-of-pocket medical expenses.
Medicaid is a government entitlement program that provides health care to qualifying low-income individuals and families. It is jointly funded by the federal and state governments, although it is administered at the state level. Each state may have it’s own name for the program, as well as it’s own set of guidelines for eligibility and services. The CMS is responsible for monitoring the state-run programs and setting requirements for service, delivery, quality, funding, and eligibility standards.
- Medicaid is the largest source of funding for medical and health-related services for people with limited income
Being poor does not automatically qualify an individual or family for Medicaid benefits. To be eligible, one must fit into an eligibility group that is recognized by federal and state law, as well as meet certain requirements within each group. Among the groups covered are low-income parents, children, seniors, and people with disabilities. Some of the requirements involved are age, pregnancy, disability, blindness, income, assets, resources, citizenship or immigrant status.
When health care is provided by a participating health care professional or medical facility, Medicaid will pay all or a portion of the bill. The payment is sent directly to the health care provider, the money is not sent to you. In some cases, a patient may be asked to pay a small portion of the cost for some medical services.
The State Children’s Health Insurance (SCHIP)
The State Children’s Health Insurance (SCHIP) was created in 1997 to provide health insurance for uninsured children whose families were of limited income and could not afford private insurance, yet made too much money or had too many assets to qualify for Medicaid.
The SCHIP program is jointly funded by the federal and state governments and administered by the states. Although each state must follow general federal guidelines, each state is allowed to determine it’s own program structure, eligibility groups, benefit packages, payment levels for coverage, and administrative procedures. The program may also be called different names in different states.
- SCHIP provided health care coverage for 6.6 million children during 2006
The SCHIP program helps families have access to medical and dental care for children. With this program, many health care expenses are covered in full, although in some instances patients may be asked to pay a small co-pay amount.