Health Insurance & Assistance - FAQs:

You may want to consult the HHS Health Resources Services Administration (HRSA) directory of health centers at http://findahealthcenter.hrsa.gov/ - these health centers provide care on a sliding fee scale so it is affordable for anyone. You can receive care even if you are uninsured or cannot pay. Search the directory by zip code to find the centers nearest you.

The Hill-Burton program, while limited in scope, provides funds to hospitals and other health care facilities in exchange for their provision of a specified amount of free or reduced cost health care to low-income people. To find out if you qualify for Hill-Burton assistance you must apply at the admissions or business office at a Hill-Burton facility. Also see the directory of Hill-Burton facilities (HRSA).  

The State Children's Health Insurance Program (SCHIP) expands health coverage to uninsured children whose families earn too much for Medicaid but too little to afford private coverage. For more information, visit www.insurekidsnow.gov or call toll free 1-877-KIDS-NOW (1-877-543-7669). This Web site and toll free number also provides information on Medicaid.

Community health centers provide health care regardless of your ability to pay and even if you have no health insurance. Find the community health center closest to you. Phone the community health center for more information or to make an appointment.

Good health is important to everyone. If you can't afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.

Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services. In general, you should apply for Medicaid if you have limited income and resources. You must match one of the descriptions below:

Pregnant Women

Apply for Medicaid if you think you are pregnant. You may be eligible if you are married or single. If you are on Medicaid when your child is born, both you and your child will be covered.

Children and Teenagers

Apply for Medicaid if you are the parent or guardian of a child who is 18 years old or younger and your family's income is limited, or if your child is sick enough to need nursing home care, but could stay home with good quality care at home. If you are a teenager living on your own, the state may allow you to apply for Medicaid on your own behalf or any adult may apply for you. Many states also cover children up to age 21.

Person who is Aged, Blind, and/or Disabled

Apply if you are aged (65 years old or older), blind, or disabled and have limited income and resources. Apply if you are terminally ill and want to get hospice services. Apply if you are aged, blind, or disabled; live in a nursing home; and have limited income and resources. Apply if you are aged, blind, or disabled and need nursing home care, but can stay at home with special community care services. Apply if you are eligible for Medicare and have limited income and resources.

Other Situations

Apply if you are leaving welfare and need health coverage. Apply if you are a family with children under age 18 and have limited income and resources. (You do not need to be receiving a welfare check.) Apply if you have very high medical bills, which you cannot pay (and you are pregnant, under age 18 or over age 65, blind, or disabled).

Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services. To contact your Medicaid office, look up your State or Territory in the Contacts Database.

Find Free or Reduced Prenatal Care:

• Call 1-800-311-BABY (1-800-311-2229) - This toll-free telephone number will connect you to the Health Department in your area code.
• For information in Spanish, call 1-800-504-7081
• Call or contact your local Health Department.

Resources for Healthy Pregnancy:

• Prenatal services (HRSA)
  Learn about the five ways to have a healthy pregnancy and finding local prenatal services.
   
• Healthy Pregnancy (womenshealth.gov)
  Information on regular doctor visits, check-ups, prenatal tests and procedures, fact sheets, and resources.
   
• Depression During and After Pregnancy: A Resource for Women, Their Families, and Friends (HRSA)
  Learn the signs of perinatal depression, what to do, and where to find help
   
• Newborn Screening (CDC)
  Information about infant screening programs
   
• Healthy Start (HRSA)
  Learn about this local outreach program mandated to reduce infant mortality in 38 states, the District of Columbia, and Puerto Rico.
   
• Maternal, Infant, and Early Childhood Home Visiting Program (HRSA)
  Through the Home Visiting Program, nurses, social workers, or other professionals meet with at-risk families in their homes, evaluate the families’ circumstances, and connect families to the kinds of help that can make a real difference in a child’s health, development, and ability to learn - such as health care, developmental services for children, early education, parenting skills, child abuse prevention, and nutrition education or assistance.
   

• Cares for patients at its facility at the National Hansen's Disease (Leprosy) Clinical Center in Baton Rouge, Louisiana. It is the only facility in the US devoted to the diagnosis, treatment, and research concerning Hansen's Disease.
• Oversees Ambulatory Care Clinics clinics in Arizona, California, Florida, Illinois, Massachusetts, New York, Texas, Washington, and Puerto and makes referrals for treatment.
• Consults with private sector physicians and accepts referrals for patients with Hansen's disease-related complications.
• Advances treatment and educates medical professionals about Hansen's disease.
• Conducts biomedical research on Hansen's disease.
• Reaches out to medical professionals with a comprehensive Hansen's disease training program.

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

Learn More with this Medicare.gov information:

• Medicare Advantage (Part C)
• Your Guide to Medicare Private Fee-for-Service Plans (PDF - 28 pages)
• Your Guide to Medicare's Preferred Provider Organization (PPO) Plans (PDF - 32 pages)
• Your Guide to Medicare Special Needs Plans (PDF- 20 pages)
• Use Medicare's Information on Quality to Help You Compare Plans (PDF - 5 pages

The Administration on Healthcare Research and Quality (AHRQ) offers an advice column on "Navigating the Health Care System" written by Dr. Carolyn Clancy. She has a column that can answer this and other related questions about compliants

Read her column: How to Complain--and Get Heard!