Health Plans Funded by the Government
In order to assist those who are unable to obtain individual health insurance the United States government has instituted various programs to help people with the cost of health care. These programs are not available to everyone and do require individuals to apply for them. However, for those who qualify these programs are extremely beneficial, especially for patients undergoing expensive treatments like those associated with a diagnosis of cancer.
Medicare is a program funded by the U.S.’s Social Security system. For those eligible, it provides health insurance and is divided into four main parts. Overall, Medicare does provide basic health coverage, but does not pay for all of a patient’s medical expenses. The amount of coverage available can vary according to state. Medicare has three main requirements of which at least one must be met in order to qualify:
- The person must be 65 or older (those who are younger and have cancer can qualify for benefits under the Supplemental Security Income program)
- Be permanently disabled and receiving disability benefits from Social Security
- Have permanent kidney failure being treated with dialysis or a transplant
As previously mentioned Medicare is divided into four parts labeled part A-D. The following is a breakdown of the benefits associated with each part: Part A
—Pays for home health care, hospital care, hospice, and care provided in Medicare-certified nursing facilities. This part of Medicare requires people to pay a yearly deductible before funds are provided, but there is not a monthly premium associated with this program. This part of Medicare allows patients to see any doctor or supplier that accepts the program and private insurance such as Medigap can be added to this plan in order to assist people with paying deductibles, co-insurance, or other costs not covered by Medicare Part A. Part B
—This part of Medicare covers diagnostic studies, doctor services, medical equipment for in-home use, and ambulance transportation. Unlike Part A, Part B does include a monthly premium which is based on the patient’s income. Part B is optional for those on Medicare and patients must pay their own medical expenses equal to the deductible before Part B assists them financially. However, patients do not pay the providers actual charge as Medicare determines what is known as a “reasonable charge” for services. Under this part patients are responsible for co-payments of the covered charges for the rest of the year. Part C
—A combination of Parts A and B, Part C of Medicare is provided by private insurers that are Medicare approved. These private companies must provide all the same hospital and medical benefits that Medicare does. These companies usually charge a monthly fee and is not available everywhere. For those with long-term health problems, there is the Part C Medicare Special Needs plan which must include Parts A, B, and D coverage. This part sometimes also includes Part D prescription drug coverage, and can be a PPO, HMO, or a fee-for-service plan. Part D
—An optional service through Medicare, Part D assists patients with their prescription drug payments purchased at retail pharmacies. This part requires patients to pay a monthly premium, as well as part of the cost of prescriptions. This part of Medicare also has a yearly deductible and co-payments which all vary according to the patient’s specific plan. Extra assistance is available for those who have limited income or resources in which the patient may not be responsible for premiums or deductibles, as well as additional financial assistance. Determination of additional Medicare benefits is determined by the Social Security Administration.
Another government program aimed at assisting with medical costs is Medicaid. Medicaid is available for:
- Low-income families with children
- Supplemental Security Income recipients
- Infants born to Medicaid-eligible pregnant women
- Pregnant women whose income is below the poverty level
- Children under the age of 6 from low-income families (this is only available in some states, and children are sometimes eligible even when other family members are not)
- Those on Medicare having trouble paying out-of-pocket costs
Veteran and Military Benefits
U.S. Veterans are eligible for Veterans Administration health benefits as long as they were once listed as being on active duty. The amount of a veteran’s benefits is determined according to their length of service, discharge received, disability, income, and the VA services available in the patient’s area. These benefits change often and the services available vary greatly by region. TRICARE is a program for those in the military as well as certain family members, survivors, retirees, and reservists provided by the Department of Defense. Tricare has nine different plans available covering those in the States and abroad including family plans, pharmacy plans, dental, and other special services with various combinations which all contain various limits and requirements. The Civilian Health and Medical Program of the Department of Veterans Affairs was created to provide spouses, children, and widows or widowers of service members who do not otherwise qualify for TRICARE. This program is a comprehensive health care program in which the costs of certain services and supplies are shared by the VA and administered by the VA Health Administration Center. Eligibility for this program includes spouses and children of the following veterans:
- Those permanently and totally disabled due to a service-related disability
- Veterans or service members who were rated permanently and totally disabled due to a service-related condition at time of death
- Those service members whose death was caused by a service-related condition
- Service members that died in the line of duty whose family members are not eligible for TRICARE.
Finally, members of military reserve units have rights pertaining to their private medical coverage should they be called up to duty. This program requires that employers allow reservists to pay the full cost of their insurance while they are away and upon their return be immediately re-instated without the standard waiting time for eligibility. Those diagnosed with mesothelioma often incur large medical costs including treatment, drugs, and other expenses such as in-home care. Programs like the ones listed above can assist those with mesothelioma in battling these costs. Patients can speak with their doctor, social security office, or local VA center in order to obtain more information about these programs and to inquire about eligibility.