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Facts Regarding Government Paid Health Insurance

Government insurance programs such as Medicare and Medicaid are major components of the national health care system. These programs offer most of the same basic services as private insurers, and for lower payments. However, many patients with government health insurance end up footing a portion of their medical bill, the same as they would with a private insurer.

  1. Eligibility

    • Eligibility for a government insurance program typically depends on age or income. Medicare is a federal program that provides free hospital treatment for legal United States residents who have reached age 65 and have paid Medicare taxes for at least 10 years. Those with certain disabilities or kidney disease may also qualify. The federal government and individual states combine to fund Medicaid for low-income people in certain categories. These categories include children and parents of eligible children, pregnant women, nursing home residents and people with disabilities.

    Hospital Stays

    • Medicare Part A covers hospital expenses, including food, tests and fees. It covers the first 60 days of hospitalization in full after a deductible, which in 2010 was $1,100. Between 60 and 90 days in a hospital, the patient owes a daily co-payment that in 2010 was $275. The co-payment doubles for each day between 91 and 150. For any days beyond 150, the patient pays all costs. Medicaid coverage for hospital stays depends on various factors regarding the patient, including income level. For example, people from families whose income is more than 150 percent of the poverty line may share up to 20 percent of the costs. The total charge may not exceed 5 percent of the family's income. Also for patients at that income level, Medicaid might not pick up any of the cost for non-emergency hospital visits.

    Medical Insurance

    • Medicare Part B is the component that pays for services on an outpatient basis. Coverage includes doctor's visits, x-rays, lab tests and various treatments such as dialysis or chemotherapy. Standard Part B premiums were $110.50 per month as of 2010, but $96.40 per month for anyone who paid the premiums through deductions from their Social Security check. Premiums generally were higher than $110.50 for people who made more than $85,000, or married couples who made more than $170,000. Medicaid covers basic outpatient services and does not charge premiums unless the patient's income or his family's income is more than 150 percent of the poverty line. For all patients, the total charge may not exceed 5 percent of income.

    Prescription Drug Coverage

    • Private insurance companies run Medicare's prescription drug program, also known as Part D. Many of the details, such as monthly premiums and which drugs the program covers, are up to the individual companies. A typical monthly premium in 2010 was $35 to $37 a month. Singles whose annual income was below $14,355 could apply to receive financial assistance for Part D premiums. Medicaid classifies certain prescription drugs as "preferred" based on cost and efficacy. In the cases of patients whose income or whose family's income is more than 150 percent of the poverty level, Medicaid may charge up to 20 percent of the cost for non-preferred drugs.

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