GET HEALTH COVERAGE THROUGH A PUBLICLY-FUNDED PROGRAM

Enroll in Medicare

You're eligible to enroll in Medicare at age 65 – earlier if you have a disability or permanent kidney failure. Keep in mind that Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage managed care plans), and Part D (prescription drug plans) – and each part has a different, often complicated, enrollment process. For details, see "How to get started," below.

If you don’t already have a Medicare Advantage plan, you can also buy a Medigap policy to fill the gaps in coverage not offered by A, B, C or D. There are 12 standard Medigap policies (Medigap Plans A – L), and insurers selling Medigap must follow state and federal laws designed to protect you.

Cost: For most people, Medicare part A is free. (You might have to pay a monthly premium if you or your spouse paid Medicare taxes for less than 10 years.) The fee for Medicare Part B is about $100 a month for 2012 – higher for those with household incomes above $170,000 – and is usually deducted from your social security payment.

Medicare doesn't control the cost of Part C (a Medicare Advantage managed care plan); you'll have to call each plan that offers it in your area. Fees for Part D (prescription drug plans) vary widely but average about $38 a month.

Pros:

  • Medicare offers more and better coverage at a lower cost than most other plans can offer.
  • If you’re still employed and have a good employer-offered health plan, you can often supplement it with the parts of Medicare that work best for you.
  • You can usually get the coverage you want by picking and choosing among the various plans.

Cons:

  • Medicare’s many parts – and the many options in coverage, premiums, co-pays, and provider network offered by some parts of Medicare – can be confusing and difficult to navigate.
  • Some plans are limited to a certain geographic area; if you’re outside that area, you make have to pay out of pocket for some health-related expenses.

How to get started:
Parts A and B: If you're already getting social security or railroad retirement benefits, you'll be automatically enrolled; a Medicare card and other information will be mailed to you about three months before your 65th birthday (earlier if you're already getting benefits). If you're not yet getting social security or certain other benefits, call (800) 772-1213 or visit a social security office for details on how to enroll.


Part C: Once you've enrolled in Medicare Parts A and B, you have six months to enroll in any Medicare Advantage managed care plan that's available in the county where you live -- without a medical screening.  After that most plans offer open enrollment at least one month each year, usually in November -- also without a medical screening.


Part D: You can enroll in a Medicare Part D prescription drug plan anytime from three months before you turn 65 to three months after turning 65. If you miss that window, you can enroll during the annual general enrollment period – usually mid-November until the end of December – but you'll have to pay a penalty.

Tip: You can get free advice to questions about Medicare – and help sorting through insurance options, understanding medical bills, and appealing Medicare decisions – through your State Health Insurance Assistance Program (SHIP). To find your state's office and phone number visit the SHIP locator website.

Enroll in Medicaid

If you're 65 or older or have a long-term disability – and you have limited income and few assets other than the home you live in – you may be eligible to enroll in Medicaid, a federally mandated program designed to provide healthcare coverage to those in need.

Cost: For those whose income falls below the eligibility standard for the federal
Supplemental Security Income
program known as SSI (about $700 per month of what's called &quotcounted&quot income but sometimes up to about $1,500 a month), it's free for most services.

Pros:

  • Medicaid covers the same health care services that Medicare does, as well as some that Medicare doesn't cover, including some prescription drugs not covered by the Medicare Part D prescription plan.
  • It also pays for Medicare premiums, deductibles and co-payments for those who are enrolled in both Medicaid and Medicare.

Cons:

  • Because Medicaid doesn't reimburse doctors and other health care providers at the same rate as private insurance, it can be hard to find a provider who accepts Medicaid.

How to get started: 
Because each state administers its own version of Medicaid, each with slightly different rules and coverage, you'll need to contact one of the local offices of your state's Medicaid program. To find a local Medicaid office near you, go to the official Medicaid website, and click on your state.

Tip: When you enroll in Medicaid, ask your local Medicaid office if any Medicaid managed care plans are available to you and how they work. They operate much like any HMO and are usually a better option than trying to find individual providers who accept Medicaid patients.

Apply through either your state's high-risk health insurance pool or the federal high-risk health pool

If you've been turned down by individual health insurance companies because of a pre-existing condition such as cancer or HIV and don't have any other options, you may be eligible for health insurance through either your state's high-risk insurance pool or the federal high-risk pool.

Cost: It's usually the most expensive option, but state laws generally cap the cost at no more than 125 to 150 percent of the usual market rate. The federal high-risk pool is usually less expensive than state pools.

Pros:

  • Once you're enrolled, your insurance usually looks and works just like any other private insurance coverage.

Cons:

  • You’re not eligible for the federal high-risk pool if your state has its own high-risk pool.
  • There’s often a waiting period of up to six months before you’re eligible.

How to get started: You can apply through an insurance agent, a broker, or directly with your state. Or go to healthcare.gov to find coverage in your state.

Tip: Both state and federal high-risk health pools will be replaced by insurance exchanges in 2014 when the new health reform law goes into full effect.