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Medicaid and Other Income-Based Programs
 Medicaid, which became law in 1965, is a federal/state program that pays for medical care for individuals and families with very low incomes, typically at or below the federal poverty line (FPL). The FPL today is approximately $10,000 for a single individual and $20,000 for a family. Approximately 38 million Americans today are on Medicaid (see Appendix B). An estimated 6.5 million of the 43 million Medicare beneficiaries also receive Medicaid—mostly for prescription drug coverage. This is expected to end in 2006 when the new Medicare Prescription Drug Plan Part D becomes effective (see Chapter 8).

Tip: There are many ways to qualify for Medicaid if your income is close to or below the FPL, or if you have a disability and income of up to 250 percent of the FPL. Contact the health insurance department in your state for questions about Medicaid eligibility and benefits (see Appendix A).

Other Income-Based Programs
In addition to Medicaid, most states have other programs for people of moderate incomes who earn too much to qualify for Medicaid.

California has a program called “Healthy Families” for children and teens whose families earn too much to qualify for Medicaid. The premium is only $27 per month for all children under 19—a family of four qualifies if their family income is less than $48,000 a year.

New York has a program called “Healthy New York,” which is available only to people employed in the state for at least 12 months by an employer that does not offer employer-sponsored health insurance. The premium is approximately $177 per month for an individual and $510 per month for a family. This is about 60 percent less than the premium for a comparable individual/family policy in New York shown in Appendix A.

Becoming Eligible for Someone Else's Health Insurance or Medicaid
If you have a relationship with an individual who has good health insurance from any source, you should explore what you can legally do to become eligible for coverage under that person's health insurance policy, as either a dependent or a domestic partner. For example, the Summary of Plan Document (SPD) of many large employee-benefits plan is fairly liberal in defining “eligible domestic partner”—which is the same as a spouse for eligibility in an employer-sponsored group benefits plan. Some large companies, like Chevron/Texaco, heavily subsidize the cost of the spousal premium.

You should never do anything illegal to qualify for health insurance. In addition to criminal and civil penalties, there is no statute of limitations for fraud. As explained in Chapter 4, your health benefits could be canceled years from now retroactive to your initial date of application.

 

  
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