Overview on USA Healthcare Insurance - Medigap Supplemental Insurance, Medicaid and State Children Health Insurance Program

Medigap Supplemental Insurance, Medicaid and State Children Health Insurance Program

Medigap Supplemental Insurance

Since Medicare does not provide coverage for all the medical expenses incurred as part of the treatment, the individuals who do not possess any other health insurance cover and decide not to enroll in a Medicare Advantage Plan, may decide to avail a Medigap policy. Medigap is private insurance that helps to cover some of the prevailing gaps in Medicare benefits. Since 1992, there have been 10 standard Medicare supplemental policies. These Medigap policies are designated by the letters A through J. In 2005, two new Medigap policies—designated by the letters K and L—were added. Medigap policies K and L have higher out-of-pocket amounts and lower premiums than policies A through J. Although all the 12 standard policies may not be available to an individual where he/she resides, supplemental Plan A is available to Medicare beneficiaries across USA.

In addition to the aforementioned policies, other government-sponsored programs for specific groups viz. Medicaid and the State Children’s Health Insurance Program (SCHIP) for low-income individuals and their families and health insurance plans that meet a specific need, such as long-term care, supplemental coverage and disability insurance, are also available in USA.

Medicaid

Medicaid provides healthcare coverage for certain categories of individuals with limited income are eligible to participate in the program. Medicaid is a Federal-State program that is operated by the States on an individual basis. Each State sets its own rules regarding eligibility and services covered under the plan. Many groups of people are eligible to apply for Medicaid coverage. However, some of the factors affecting eligibility include age, whether an individual is pregnant, blind or disability, an individual’s income and resources and whether he/she is a U.S. citizen or a legal immigrant etc needs to be considered. There are instances when a child may be eligible for coverage even if the concerned individual may not be eligible for the coverage. Eligibility for children is based on the child’s status and is not dependant on the parent’s status. If an individual’s income is limited and he/she is unable to afford the medical facilities needed by him/her, he/she should apply for Medicaid irrespective of whether he/she qualifies for the same or not. A qualified insurance professional will evaluate to determine whether an individual qualifies for eligibility or not under Medicaid.

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State Children’s Health Insurance Program

State Children’s Health Insurance Program (SCHIP) was introduced in 1997. SCHIP is a Federal/State partnership similar to Medicaid. SCHIP expanded health insurance coverage to children whose families earn money to be eligible for Medicaid but not enough to purchase private insurance.

Just like Medicaid, SCHIP eligibility and covered services varies from State to State across USA. In certain States of US, Medicaid and SCHIP are combined. In some States, both – SCHIP and Medicaid operate as separate programs. Although health benefits covered by SCHIP vary, all States must provide coverage for well-baby and well-child care, immunization programmes and emergency services.