Federal Programs:

Medicare, Medicaid, CHIP and SSI

Despite major changes to the health care system under The Affordable Care Act, federal programs like Medicaid, Medicare and CHIP will continue to be offered by every state and, in some states, will be expanded to ensure that coverage is available to those who need it.

If you are currently enrolled in one of these programs or would like to know if you qualify, please see the links below.

The Basics: Understanding the Different Programs

(A special thank you to the Elder Care and Disability Law Center in Washington, DC for helping to define the different government programs for our readers.)


Medicare
Medicare is a national health insurance program. Individuals entitled to Social Security Retirement Insurance who are sixty-five (65) years old or older, and individuals entitled to Social Security disability benefits for not less than twenty-four (24) months (such as younger individuals with certain disabilities,, are eligible to participate in Medicare. Medicare is an “entitlement” program. An individual is entitled to Medicare benefits if he or she has earned Social Security retirement benefits, that is, worked the necessary calendar quarters or units. Unlike Medicaid, neither Medicare eligibility nor benefits are predicated upon income or assets of the beneficiary.

Medicare was started in 1965 and is intended to ensure a basic level of health care for the aged and disabled. It is funded through employee payroll contributions and collected as part of payroll deductions (1.45% of wages with no cap [2012]). Medicare benefits are paid entirely by the federal government; there is no state contribution. It is designed on a private insurance model. The program requires deductibles, co-payments by the insured, and monthly premium payments for Part B (which covers physician’s fees, medical supplies and other outpatient medical services). Claims are submitted to providers contracted by the federal government.

 

Medicaid
Medicaid is a program established by the federal government in partnership with each state that helps pay medical costs for qualified individuals. It is administered by each state, thus the rules of coverage vary. It is not a medical insurance program. Instead it is a public assistance welfare program run by state governments with partial funding by the federal government designed to pay the medical costs of a “categorically needy” group of individuals and families especially deserving of medical public assistance because of their circumstances.

 

Supplemental Security Income (SSI)
Supplemental Security Income (SSI) is a federal benefit program that provides income to qualified individuals. It is not a medical benefits program; however in most states an individual who is eligible for SSI is automatically eligible for community based Medicaid. Qualified individuals are those who are younger than 65 and are blind or disabled. The program is designed to provide a guaranteed income to those who cannot earn a sufficient income from employment to provide for basic food, shelter, and clothing. The maximum federal monthly benefit in 2012 is $698 per month for an individual and $1,048 for a couple. SSI is an important benefit program because many of the Medicaid eligibility rules are founded in SSI eligibility rules.

 

Children’s Health Insurance Program (CHIP)
(Information from www.medicaid.gov)
The Children’s Health Insurance Program (CHIP) is a federal program that provides funding for health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage. Signed into law in 1997, CHIP provides federal matching funds to states to provide this coverage. Like Medicaid, every state administers its own CHIP program with broad guidance from the Centers for Medicare & Medicaid Services (CMS) under the Department of Health and Human Services.

States can design their CHIP program in one of 3 ways:

  • Medicaid expansion (7 states, DC and 5 territories)
  • Separate Child Health Insurance Program (17 states)
  • Combination of the two approaches (26 states)

Helpful Resources

Below is a list of resources you can visit to learn more about programs offered in your state.

Centers for Medicare and Medicaid Services (CMS) has posted a comprehensive list of resources to navigate individuals through the Open Enrollment period:

  • Medicare & You 2013 handbook: If you are currently enrolled in Medicare, this book was mailed to you in September. Be sure to take a couple of minutes to review it.
  • Extra Help Program: For individuals with limited income and resources, the Extra Help program assists with paying prescription drug coverage costs. For more information, visit www.socialsecurity.gov/i1020 or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.

 

American Association of Retired Persons (AARP) has developed a series of fact sheets:

 

InsureKidsNow.gov, Sponsored by the U.S. Department of Health and Human Services

ACA Markteplace

 

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