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  • Getting Health Insurance Coverage

     

     

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    People without health insurance can get coverage in a few ways, by:

    • Buying group insurance through an employer or other organization (such as a union or civic group)
    • Buying individual or short-term insurance
    • Getting coverage through federal and state programs (such as Medicare and Medicaid)
    • Getting coverage on your parent’s health plan (if you are under 26)

    Group insurance

    Although employers are the main source of group insurance coverage, organizations such as unions, professional associations, churches and civic groups may also offer insurance to their members. Because these policies are set for a group of people rather than one person, the premiums tend to be lower.  

    Many states have programs called “high-risk pools” that sell health insurance to people who have medical conditions and cannot find an insurer at an affordable rate. To find out if your state has a high-risk pool, contact your state insurance commissioner's office.

    Individual insurance

    When you buy insurance as an individual, rather than as a member of a group, you usually pay higher premiums. However, in some cases, individual policies give more options that tailor benefits to your needs. To find out more about buying individual insurance, contact an insurance agent or broker, your state insurance commissioner's office or your state health department.  

    Medicare

    Medicare is health insurance provided by the federal government to people who are 65 years of age or older, on renal dialysis or permanently disabled.

    Medicare Part A and Part B

    Basic Medicare has two parts:

    • Medicare Part A covers hospital costs and some post-hospital care.
    • Medicare Part B covers medical costs, including some equipment, supplies and ambulance transportation.

    Medicare does not provide comprehensive health care. It does not directly pay for prescription drugs, although there are insurance companies that work with Medicare to help cover the costs of medications. It also does not cover experimental treatments or services outside the United States. However, as part of the Affordable Care Act (health care reform), Medicare now covers a yearly wellness visit, screening mammograms and some other preventive services.  

    Medicare plans have co-payments and deductibles. The deductibles on Part A coverage are paid more often than with most health plans (every 60 days instead of every year).

    Medicare advantage plans

    Medicare Part C (Medicare advantage plan) is run by private insurance companies (such as health maintenance organizations (HMOs) and preferred provider organizations) under contract with Medicare. Medicare Part C includes Part A and Part B, but costs for services vary depending on the plan. Some plans offer prescription drug coverage.

    Medicare prescription drug coverage

    Medicare Part D (Medicare prescription drug coverage) is run by private insurance companies under contract with Medicare. These plans help cover prescription drug costs.  

    For more information about Medicare, call the Medicare Hotline at 1-800-MEDICARE (800-633-4227) or visit www.medicare.gov.

    Medigap (Medicare supplemental insurance)

    A Medigap policy is private supplemental (extra) insurance that fills in “gaps” of Medicare coverage. It pays for some Medicare costs (like co-payments) and some services not covered by Medicare Part A and Part B. If you have Medicare Part A and Part B (and do not have a Medicare advantage plan) you can buy a Medigap policy.  

    There are many Medigap policies with different coverage. The most basic plan covers items such as the co-payment for Medicare Part A hospital stays. Other Medigap plans cover items such as recovery at home and some prescription drugs costs.  

    For more information about Medicare or Medigap, call the Medicare Hotline at 1-800-MEDICARE (800-633-4227) or visit www.medicare.gov.  

    Medicaid

    Medicaid provides health care to people who have a low-income. This program is run jointly by the federal and state governments, so benefits and eligibility (who can join) vary from state to state.  

    You also may be eligible for Medicaid (even when your income level is too high to qualify) if you have very high medical expenses. For more information about Medicaid, call your state's toll-free hotline.  

    Updated 04/28/13 

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