Medicaid is a government program that provides free or low cost healthcare to low income households. But if you do not qualify for this program, help is still available.
Medically reviewed by Shilpa Amin, M.D., CAQ, FAAFP
Medicaid is a government program that helps low income households pay for healthcare costs.
To qualify for Medicaid, you need to meet certain requirements related to income level, citizenship status, state residence, and age, among others.
In 2023, about 84.5 million people in the United States are on Medicaid. However, many others are not covered by this program and need to find alternatives.
List of Medicaid alternatives
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Whatever your circumstances, it may be possible to successfully join a program that helps you and your family with healthcare costs.
CHIP
The Children’s Health Insurance Program (CHIP) provides health coverage for children from low income households that do not qualify for Medicaid.
Who’s eligible
People younger than age 18 years who come from households with an income too high to qualify for Medicaid may be able to enroll in CHIP. Each state has its own rules about who qualifies, though, so it’s worth checking with your state’s office for your specific requirements. In some states, pregnant people also qualify for CHIP.
What it covers
Even though CHIP benefits differ from state to state, all of them provide:
routine checkups and doctor visits
vaccinations
prescriptions
dental care
vision care
hospital care
lab tests and X-rays
emergency services
What it costs
Routine doctor visits and dental appointments are usually free for CHIP beneficiaries. However, depending on the state in which you live, you may have to pay a copayment for other health services.
How to apply
To apply to CHIP, you can call 800-318-2596 (TTY: 855-889-4325) or fill out an online application. To do so, you’d have to create an account with the Health Insurance Marketplace.
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If you meet eligibility requirements, you can enroll online for one of Tricare’s plans.
Medicare
Medicare is a healthcare plan that covers adults ages 65 years and older or people with specific health conditions.
Who’s eligible
Adults who are ages 65 years and older or those who have end-stage renal disease or amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, may be eligible for Medicare.
What it covers
Medicare has four parts: A, B, C, and D. Here’s what they cover:
Medicare Part A: This part covers medically necessary inpatient treatment and drugs you need during your stay.
Part B: This part covers outpatient treatment, including medications that a doctor or healthcare professional administers in a doctor’s office.
Part C: This is also known as Medicare Advantage. Private medical insurers provide these plans, which include additional benefits like dental or vision care.
Part D: This is the prescription drug plan. Private medical insurers also provide Part D plans.
What it costs
The cost of Medicare and its out-of-pocket expenses depend on which of the four parts you’re enrolled in. Plan costs can go from $0–$500.
If you receive Social Security benefits before turning 65 years old, you’ll be automatically enrolled in Medicare parts A and B, together known as original Medicare. If you decide not to receive Social Security benefits before this time, you can apply for Medicare online.
Other options you can consider are employment benefits. If you’re unemployed, you may be able to get coverage through:
In some states, other options if you don’t qualify for Medicaid are state-based healthcare programs. These health insurance marketplaces allow you to enroll for lower cost healthcare.
Keep in mind that not all states offer these programs. The states that offer them include:
California
Colorado
Connecticut
Idaho
Kentucky
Maine
Maryland
Massachusetts
Minnesota
Nevada
New Jersey
New Mexico
New York
Pennsylvania
Rhode Island
Vermont
Washington
Washington, D.C.
Each state-based health program has a different name. For example, the health marketplace in California is called Covered California, whereas it’s called New York State of Health in New York.
You may want to look up the specific health marketplace for your state, along with eligibility requirements, costs, and information on how to enroll in the websites of each state’s health marketplace.
Through your state’s healthcare marketplace, you can buy health insurance for a lower cost. Health plans can cost as low as $10 per month. Though each program differs, the plans generally cover doctor’s visits, urgent care, hospital visits, and some prescription medications.
Summary
Medicaid is a government program that offers free or low cost health services to people from low income households.
To qualify for Medicaid, you’d have to meet some income, age, and citizenship requirements. If you or your loved ones don’t qualify for Medicaid, you have other options, including CHIP for people under 18 years, Tricare for military personnel and their families, and Medicare for people ages 65 years and older.
You can also consider state-based programs that may offer healthcare plans at a lower cost.
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