See If You Qualify for One of These Affordable Health Care Options!

• Author: Jessica Williams
• Posted: 2024-08-20

If you live in the United States, chances are that you're aware of how the health care system is different from most systems around the world. While taxes alone cover health care costs in most developed countries, the United States has held onto its private payer health care system. For better or worse, this is the system with which United States residents have to deal. However, you shouldn't lose hope when it comes to covering health care costs.

In this article, we'll go over some options that can save you money the next time you see the doctor, fill a prescription, or go to the Emergency Room.
 

Medicaid

Medicaid is the single largest healthcare payer in the United States. It covers tens of millions of low-income residents. Interestingly, the implementation of this critical health care solution is left up to individual states. This means that certain states, mostly those in the southeast, can determine that an individual must be disabled as well as low-income to receive Medicaid benefits.

Typically, Medicaid programs are reserved for those below 133% of the Federal Poverty Line. This equates to income of about $1600 per month, but it does vary by state. For example, those who live in California have different income limits than those in most other states.

Medicaid Managed Care Organizations (MCOs) provide a host of benefits for Medicaid recipients. These organizations provide additional prescription drug benefits, and in some cases, dental and vision benefits to those who receive Medicaid. They also have certain fringe benefits, often covering medical transportation and even providing reimbursement for college applications.

Remember, Medicaid is different from Medicare. Medicare is reserved for those who are ages 65+, and it is an entitlement to older folks who require health care. Medicare is a system that everyone pays into via payroll taxes. Medicaid, on the other hand, is funded by federal income tax.
 

What Counts As "Disabled" for Medicaid?

If you live in one of the handful of states that requires you to be disabled to receive Medicaid benefits, you may be wondering what counts as disabled in this context. While federal rules do not require this to be a condition of receiving it, many states in the southeast dictate that you have a disability to receive these benefits.

In order to qualify as "disabled," having a diagnosis from a doctor alone is not enough. Rather, you will need to get a statement from the Social Security Administration (SSA) that you are, in fact, disabled. This will ordinarily require you to have both this decree as well as SSDI or SSI benefits paid to you monthly. If you do not hit this high bar, you will not be considered "disabled," and chances are that the state will not allow you to receive Medicaid benefits.
 

The Affordable Care Act

The Affordable Care Act (ACA) is another framework to receive health care benefits. It's particularly useful if you do not qualify for Medicaid or are not able to get Medicaid because of your state's rules for doling out the benefit.

This is a marketplace of private health insurers. Unlike the traditional, private marketplace, however, it relies on government subsidies to decrease costs. Unlike Medicaid, this is typically not a free benefit. However, it is often heavily subsidized. The amount of subsidy you qualify for will depend on the amount of income you get per year, according to the IRS.

Some states operate their own marketplaces, also called "exchanges." These exchanges are run using federal tax dollars, but the state imposes slightly more control. To see whether your state runs a healthcare exchange or you need to use the federal one, you will need to go to healthcare.gov and enter in your state of residence. From there, you can proceed to look at plans and pick out your coverage today.
 

What If I Need More Help?

If you need more help, there's good news for you! There are marketplace brokers waiting to speak with you about the health plans for which you qualify. If you qualify for Medicaid in your state, chances are that there are MCO brokers waiting to speak with you as well. In any case, you should not delay getting your health care benefits, as there are plenty of qualified professionals awaiting your call to assist with obtaining your new health insurance, whether through the ACA or Medicaid.