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Types of Health Coverage

Learn more about types of health coverage and changes due to the ACA.

Private health insurance

Private health insurance includes both individual plans and group plans. Group plans are typically offered through your employer. Group plans may cover as few as two people or as many as thousands of employees. Individual plans may be purchased by an individual or family.

Private health insurance plans vary in their health and mental health benefits. Some plans offer limited benefits and high deductibles, while other plans may offer comprehensive benefits with low deductibles or co-pays. Typically, private insurance offers fewer mental health services than Medicaid or public mental health programs.

Private insurance is changing. Find out how the changes will affect you and how to protect your rights with insurance plans. Read more.

Medicaid

Medicaid is a public health insurance program that provides coverage to children, pregnant women, families, people 65 or older and people with disabilities who also qualify as low-income according to state rules. Many states have expanded eligibility for Medicaid to people with incomes of 0 to 138 percent of the federal poverty level (FPL).

Medicaid programs go by different names in every state and eligibility varies. In most states, adults without children are not eligible unless they are disabled and receive Supplemental Security Income (SSI).

Covered services vary by state, but all Medicaid programs cover health and mental health services and prescription drugs. In many states, Medicaid covers mental health services that are often unavailable through private insurance, such as case management, psychiatric rehabilitation and peer support services. Medicaid plans have low costs, but your choice of providers may be more limited than in private health insurance plans.

Medicaid is changing in 2014. Learn more.

Medicare

Medicare is a federal health insurance program for older Americans (ages 65 or older) and adults with disabilities who receive Social Security Disability Insurance benefits (SSDI) because they are not able to work full time. However, Medicare coverage does not begin until 24 months after you are entitled to receive SSDI benefits. Medicare is sometimes confused with Medicaid, which is a public health insurance program for low-income Americans.

Medicare provides coverage similar to private health insurance coverage. Mental health services are covered if they are provided by a doctor, psychiatrist, clinical social worker or clinical psychologist. There is a 190-day lifetime limit on psychiatric hospital care. Medicaid, in contrast, often offers a wider range of mental health services and lower costs.

If you have limited income and resources, you may be eligible for help with Medicare costs. You may also be eligible for additional coverage under Medicaid.

CHIP (Children’s Health Insurance Program)

CHIP is a public health insurance program for children in families who earn too much to qualify for Medicaid but not enough to buy private health insurance. CHIP programs go by different names in every state and eligibility and benefits vary.

In general, if you are a family of four and your yearly income is under about $47,100 a year, your children will be eligible for free or low-cost health insurance. In some states, you can have a higher income and your children may still qualify.

TRICARE and VA Health Care

If you have served in the military, you may be eligible for coverage through TRICARE or health care through the U.S. Department of Veterans Affairs (VA). TRICARE covers active duty and retired service members and their families, including the National Guard.

TRICARE benefits are similar to private health insurance plans and include mental health services. The VA provides more extensive mental health services, like case management and psychosocial rehabilitation, but eligibility is limited.


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