UNDERSTANDING & CHOOSING YOUR INSURANCE

How should I choose among my health insurance options?

Fran Rogers, MSN, CRNP

Medicaid and the Children’s Health Insurance Program (CHIP)

PHA’s Frequently Asked Insurance Questions – Cost-Related Insurance Terms

“Get educated and be an expert in PH. Know what you are talking about and it will carry you far.”
PH Patient

Need More Information About Your Plan or Potential Plan?

Whether you are covered by a public plan or a private plan, you want to be an informed consumer. Accessing your treatment may depend on how well you know your plan and entitled benefits.

What Types of Insurance Are There?

There are many different types of insurance payers, plans and programs in the United States, each catering to different populations with different needs. Use this page to learn more about your current or potential plan.

Public Payers

Public payers are government-funded programs or types of financial support to help you pay for your medical treatments. Each program has different eligibility requirements, highlighted in the chart below, and application process.

 
 Insurance and Assistance For:
Disability Elderly & Retired Low Income Children Military & Veteran General
Public Insurance and Assistance
Medicare is a federal program that provides health insurance coverage to eligible, qualified elderly and disabled individuals. Coverage benefits vary based on the site of service (i.e. doctor’s office, hospital inpatient, hospital outpatient or home health treatments). More info  Checked box Checked box un-checked box un-checked box un-checked box un-checked box
Social Security Disability Insurance (SSDI) is most simply defined as an insurance plan that helps to cover medical expenses when you are unable to work. You are entitled to benefits if you have worked jobs covered by Social Security and you have a medical condition that meets Social Security’s definition of disability. More info Checked box Checked box un-checked box un-checked box un-checked box un-checked box
Medicaid is a series of state administered programs designed to provide health insurance coverage to individuals such as the disabled, children or pregnant women who have low income. Each state sets its own guidelines regarding eligibility and services. Find info about your state’s program Checked box  Checked box Checked box Checked box un-checked box un-checked box
Supplemental Security Income (SSI) is a federal income supplement program funded by general tax revenue (not Social Security taxes). It is designed to help aged, blind and disabled people who have little or no income, and it provides cash to meet basic needs for food, clothing and shelter. More info Checked box Checked box Checked box Checked box un-checked box un-checked box
Child Health Insurance Programs (CHIP) are state programs designed to provide coverage to uninsured children whose family income falls under a certain level. More info un-checked box un-checked box Checked box Checked box un-checked box un-checked box

Military Plans

Military plans are designed to provide and cover the costs of medical services to active duty military, retirees, veterans and their families. PHA represents the needs of TRICARE beneficiaries impacted by PH before the Uninform Formulary Beneficiary Advisory Committee, as in these comments.

 
 Insurance and Assistance For:
Disability Elderly & Retired Low Income Children Military & Veteran General
Military
Veterans Affairs (VA) is responsible for providing federal benefits to veterans and their dependents. The VA provides coverage for basic and preventative care. More info un-checked box un-checked box un-checked box un-checked box Checked box un-checked box
CHAMPVA is a health benefit program for the families of veterans with 100 percent service-connected disability and surviving spouse or children of a veteran who dies from a service-connected disability. The VA determines eligibility and processes CHAMPVA claims. More info un-checked box un-checked box un-checked box un-checked box Checked box un-checked box
TRICARE is the name of the Department of Defense’s managed health care program for active duty military, personnel, retirees and their families. More info un-checked box un-checked box un-checked box un-checked box Checked box un-checked box

Private Plans

Private plans are underwritten by either private insurance companies or private employers. Enrollment requirements and costs are determined by the company.

 
 Insurance and Assistance For:
Disability Elderly & Retired Low Income Children Military & Veteran General
Private & Other Types
Private payer plans vary greatly from company to company (and within companies) but are typically divided into two categories, indemnity plans and managed care plans. Today, virtually all private health insurance payers incorporate some form of a managed care component. un-checked box un-checked box un-checked box un-checked box un-checked box Checked box
Self-funded plans are job-based plans under which employers or unions set aside money to pay for health care expenses directly, instead of contracting for services from a private health insurance payer. In this respect, the employer or union is the insurer and carries the associated risk. un-checked box un-checked box un-checked box un-checked box un-checked box Checked box