Alyssa Lane
Depending on your location and financial situation, you may be eligible for additional health insurance or government assistance to help cover medical costs. In the US, Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to some low-income people, families, children, pregnant women, the elderly, and people with disabilities. Each state has different eligibility requirements and benefits, so it is important to check with your state's Medicaid Agency or search for local organizations that can help you apply for coverage. If you have existing health insurance, it is worth checking if you can receive additional support or qualify for Medical Assistance (MA) to help pay your premiums.
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What You'll Learn
Qualifying for Medical Assistance with other insurance
In the United States, Medicaid is a federal-state program that provides health coverage to over 77.9 million people, including children, pregnant women, parents, seniors, and individuals with disabilities. Qualification for Medicaid is dependent on income, household size, family status, disability, age, and other factors. Each state has different rules, and some states have expanded their Medicaid programs to cover nearly all low-income Americans under 65. To see if you qualify for Medicaid, you must fill out an application.
If you already have health insurance, you may still qualify for Medical Assistance (MA). MA may also pay your premium if you qualify. If you have Medicare, you may still qualify for MA to pay for services that Medicare does not cover. Similarly, you can qualify for MA even if you have long-term care (LTC) insurance. If you are enrolled in a qualified Partnership policy and apply for MA, you may be able to keep assets equal to the amount that your Partnership insurance has paid for your long-term care. These assets will not count toward the MA asset limit and will not be claimed in estate recovery.
If you are still struggling with medical bills, there are other options to consider. Charity care programs may be able to assist with remaining costs, and you can often apply for these through your doctor or hospital. Pharmaceutical companies may also be able to provide low-cost options, samples, or discounts. State social services agencies can also provide direct assistance and referrals to local health centers and organizations that may be of help.
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Medicaid and CHIP coverage
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage for some low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. Each state has its own Medicaid eligibility requirements, and coverage and costs may vary from state to state. Some states have expanded their Medicaid programs to cover all people below certain income levels, while others have their own unique rules and requirements.
Medicaid benefits are comprehensive and cover services such as nursing home care and personal care services, which are not typically covered by Medicare. Additionally, Medicaid may pay for other drugs and services that Medicare does not cover. If you have both Medicare and full Medicaid coverage, you are considered "dually eligible". In this case, Medicare pays first for Medicare-covered services, and Medicaid pays last, after Medicare and any other health insurance you may have.
CHIP provides low-cost health coverage to children in families who earn too much to qualify for Medicaid. In some states, CHIP also covers pregnant people. If you qualify for savings on a Marketplace plan, your children will likely qualify for either Medicaid or CHIP.
To find out if you are eligible for Medicaid or CHIP, you must submit an application. Eligibility is determined by factors such as income, household size, family status, disability, age, and state of residence. Even if you do not qualify for Medicaid based on income, you may still qualify for your state's program, especially if you have children, are pregnant, or have a disability. It is recommended to apply and find out about potential cost savings.
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Medicare Savings Programs
In the United States, Medicare Savings Programs (MSPs) are a set of four programs that help low-income individuals cover the out-of-pocket costs of their Medicare coverage. MSPs are a subset of Medicaid, a health insurance program for people with low income, and are sponsored by state Medicaid agencies.
MSPs are designed to relieve some or all of the out-of-pocket Medicare expenses for people with limited means. They can help with Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) premiums, deductibles, coinsurance, and copayments. MSPs can also help with the cost of prescription drugs, with beneficiaries paying no more than $12.15 in 2025 for each drug covered by their Medicare drug plan.
The four types of MSPs are:
- Qualified Medicare Beneficiary (QMB): Covers Medicare premiums (Part A, if applicable, and Part B), deductibles, copayments, and/or coinsurance. Individuals may qualify if they have an income of less than 100% of the Federal Poverty Level (FPL) and resources under $9,660 if single, or $14,470 if married.
- Specified Low-Income Medicare Beneficiary (SLMB): Covers the Medicare Part B premium.
- Qualifying Individual (QI): Covers the Medicare Part B premium. This is only available for people who don't qualify for any other Medicaid coverage or benefits.
- Qualified Disabled and Working Individuals (QDWI): Helps pay for a person's Part A premium.
It is important to note that MSPs are available even if an individual's income is higher than the federal limits listed, as some states do not count certain types or amounts of income or resources when determining eligibility. These income limits are also slightly higher in Alaska and Hawaii. To qualify for an MSP, individuals must apply through their state, which will determine which program(s) they qualify for.
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Charity care
Under the Affordable Care Act (ACA), nonprofit hospitals must offer charity care to maintain their nonprofit status with the Internal Revenue Service (IRS). However, the IRS allows hospitals to set their own rules regarding who qualifies for charity care. Some hospitals are more generous than others. Some states have passed laws requiring health care providers to offer charity care. In addition, many for-profit hospitals offer needs-based programs that provide a similar type of assistance. Whether you are eligible for charity care can vary depending on where you live and the hospital where you are treated. Each hospital runs its own charity care program and decides how patients must apply and who qualifies. Hospitals typically consider the patient’s income, the number of people in the household, and the bill’s size and age when deciding who qualifies.
If you qualify for charity care, the law requires nonprofit hospitals to refund any payments made towards that bill. Many hospitals will waive copays and deductibles. Doctors and other hospital workers separate bills for the same medical event. Most financial assistance programs only apply to hospital bills. But many policies do cover other providers like labs, radiologists, and anesthesiologists. These providers won’t automatically forgive bills when a patient qualifies for financial assistance. In most cases, patients must first get approved for charity care by the hospital, then give copies of the approval letter to the doctors and other providers.
If you don't qualify for charity care or Medicaid, or if you are still struggling to afford copays or medication that these programs don't cover, you have other options. You can search online for local or private organizations that offer financial assistance for people in need. You'll find private and nonprofit programs that offer assistance with everything from prescription drugs and treatment costs to insurance copays and premiums. CancerCare, for example, provides copay assistance for patients with certain cancer diagnoses. NeedyMeds helps people find sources of assistance to pay for medication and medical care. The PAN Foundation provides financial assistance with out-of-pocket medical expenses, including copays and medication. If you're struggling to afford expensive medication, look for pharmaceutical company patient assistance programs (PAPs). Drug manufacturers may provide a PAP for uninsured, underinsured, or low-income patients, or offer discount coupons you can use regardless of income.
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Vaccinations
Government-Funded Vaccinations
Government healthcare plans provide full coverage for vaccinations in many cases. For example, Medicare Part B covers vaccination against COVID-19, hepatitis B (if you are at increased risk), influenza, and pneumococcal. It also covers vaccines directly related to the treatment of an injury or exposure to a disease or condition, such as rabies and tetanus. Medicare Part D covers CDC-recommended adult vaccines that are not covered under Part B, including herpes zoster and RSV. If you have Medicaid coverage, or your child is covered under the Children's Health Insurance Program (CHIP), these programs provide guaranteed coverage for all CDC-recommended vaccines at no cost. TRICARE also provides full coverage for all CDC-recommended vaccines.
Private Health Insurance Vaccinations
All Health Insurance Marketplace plans and most other private insurance plans must cover certain vaccines without charging a copayment or coinsurance when provided by an in-network provider. This is true even for patients who have not met a yearly deductible.
No Insurance Vaccinations
If you don't have health insurance coverage and cannot afford to pay for a vaccine, you may be eligible for a free immunization or for financial assistance under various state and federal programs. Some community organizations and non-profits sponsor vaccine drives and other no-cost or low-cost initiatives. You can also get free or discounted vaccines through vaccine makers' patient assistance programs.
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Frequently asked questions
Yes, you may qualify for Medical Assistance (MA) even if you have other health insurance. However, you will need to apply to see if you qualify, as certain types of coverage may make you ineligible.
Yes, you may qualify for MA even if you have Medicare coverage. MA may be able to pay for services that Medicare does not cover.
Yes, you can qualify for MA even if you have LTC insurance. If you are receiving long-term care services, the cost will be shared between your LTC insurance and MA.
Not enrolling in your employer's insurance may affect your eligibility for coverage through Medical Assistance. Your eligibility will depend on the specific insurance plan offered by your employer.
Yes, there are several other options for assistance with medical bills. These include government programs like Medicaid, Medicare, ACA Marketplace, charity care programs, and state social services agencies that provide direct assistance to those with limited access to healthcare.
