YOUR GUIDE TO GOVERNMENT PLANS
There are a number of government plans for health insurance that are available to eligible participants in the United States. Those plans are under Medicaid, Medicare, and Tricare.
This page will give you an overview of these plans, and where to go to check your eligibility and get enrolled.
MEDICAID
Medicaid, a joint federal and state program, provides health coverage to eligible low-income individuals and families. While federal guidelines set broad parameters, each state administers its own Medicaid program, leading to variations in eligibility criteria, covered services, and potential coverage gaps.
Medicaid programs serve specific groups of people, including:
Pregnant women with low income
Children of low-income families
Children in foster care
People with disabilities
Seniors with low income
Parents or caregivers with low income
Under federal law, Medicaid must provide mandatory health benefits, but states can offer additional optional benefits. As a result, the populations and benefits covered by Medicaid and CHIP (Children’s Health Insurance Program) vary across states.
-
Mandatory Medicaid Benefits
Inpatient and outpatient hospital services
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services
Nursing facility and home health care services
Physician services
Rural health clinic and federally qualified health center services
Laboratory and X-ray services
Family planning services
Certified nurse midwife and nurse practitioner services
Freestanding birth center services (where licensed)
Transportation to medical care
Tobacco cessation counseling for pregnant women
-
Optional Medicaid Benefits
Prescription drugs
Clinic, physical therapy, and occupational therapy services
Speech, hearing, and language disorder services
Respiratory services
Diagnostic, preventive, and rehabilitative services
Podiatry and optometry services (including eyeglasses)
Dental services and dentures
Prosthetics and chiropractic services
Private duty nursing and personal care services
Hospice and case management services
Mental health services for individuals aged 65+ in institutions
Intermediate care for individuals with intellectual disabilities
Self-directed personal assistance services
Tuberculosis-related services
Inpatient psychiatric services for individuals under age 21
Other services approved by the Secretary of Health and Human Services
Health homes for enrollees with chronic conditions
To see if you’re eligible for Medicaid and get enrolled, visit the USA Government website or find your state’s Medicaid application online.
MEDICARE
Medicare is a federal health insurance program designed for:
Individuals aged 65 and older
Certain younger individuals with disabilities
People with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)
Unlike Medicaid, which is based on income and administered by states, Medicare is available to all eligible individuals regardless of income. There are a number of Medicare components that cover different types of care:
-
Medicare Part A (Hospital Insurance)
Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Most people do not pay a premium if they (or their spouse) paid Medicare taxes while working.
If not eligible for premium-free Part A, it can be purchased.e.
-
Medicare Part B (Medical Insurance)
Covers doctor visits, outpatient care, preventive services, and some home health care.
Requires a monthly premium (amount varies based on income).
-
Medicare Part C (Medicare Advantage)
Offered by private insurance companies approved by Medicare.
Combines Part A, Part B, and often Part D into one plan.
May offer additional benefits like vision, dental, and wellness programs.
-
Medicare Part D (Prescription Drug Coverage)
Covers prescription medications.
Offered by private insurers and requires a monthly premium.
To see if you’re eligible for Medicare and get enrolled, visit the Social Security Administration’s website.
Find Medigap Coverage
Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare.
Explore Medicare Savings Programs
Need help paying for your additional Medicare costs? Checkout the Medicare Savings Programs that are available in your state.
TRICARE
Tricare is the uniformed services health care program for active duty service members (ADSMs), active duty family members (ADFMs), National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses worldwide.
Tricare covers the following individuals:
Active duty service members and their families
Retired service members and their families
National Guard and Reserve members
Survivors and certain former spouses
Medal of Honor recipients and their families
Tricare does cover eating disorder services, including IP, RTC, PHP, IOP, and OP. For RTC level of care, it is important to note that Tricare does not cover this service for beneficiaries ages 21+ (unless an active-duty service member).
To check out Tricare plans and confirm your eligibility, visit the Tricare website or call 1-800-538-9552.
📌 For support navigating your TRICARE offerings, reach out to Sea Waves, an organization empowering the military community to prevent and overcome eating disorders through support, education and advocacy.
Find Treatment
Medicaid, Medicare, and Tricare
Store Locator is loading from Storemapper store locator...