How Women Can Know If They Are Entitled to Public Health Insurance? Medicare, Medicaid, And More Akshita Singhvi March 28, 2022 Health & Beauty 394 Health insurance plays a critical role in providing accessible and affordable health care for women. In 2020, most women aged 19 to 64 in the United States had health insurance. However, many women are still uninsured. Some may be unsure of their eligibility for public health insurance policies. Even though the Affordable Care Act has improved access to affordable health care, many women may still question their eligibility for Medicaid, Medicare, and more. Consider Private Health Insurance if You Can Afford It If you can afford private health insurance, consider getting it. Compared to public health insurance, private health insurance offers additional coverage. It pays for some or all of your medical expenses if you are treated privately. The best thing about private health insurance is that it allows you to determine the level of care you get and how it is provided. If you choose to get treated at a private facility, paying out of your pocket can be very expensive Medicaid This is a state-federal program meant to help low-income individuals. In 2020, it covered 16 percent of non-elderly adult women. Historically, eligibility for Medicaid demanded for a woman to have very low income. You had to fall in one of the following categories: Mother of children aged 18 or lower Pregnant Over 65 Person with disability However, the ACA empowered states to expand Medicaid eligibility. Individuals whose income is less than 138 percent of the FPL are mostly eligible. Your disability and family status is irrelevant. In November 2021, 38 states had improved Medicaid programs under the ACA. It covers poor populations of women. Forty-seven percent of poor women (with income lower than 100 percent FPL) and 40 percent of low-income women (with income under 200 percent FPL) are covered. In 2019, Medicaid financed about 42 percent of births in the United States. This accounts for 75 percent of publicly-funded family planning services. It is over half of the long-term care spending. According to federal law, all women with up to 133 percent of the FPL are eligible for Medicaid coverage by their states. They can’t impose cost-sharing on pregnancy-related services. States that have assumed the ACA Medicaid expansion allow women to remain on Medicaid after becoming mothers. In other states, however, you become ineligible 60 days after delivery. More than half of all states have set up programs. They use Medicaid funds to cover family planning expenses for low-income women. In some states, Medicaid programs cover the costs of cervical and breast cancer treatment for women with limited insurance. Medicare Medicare Part B covers a chest/breast exam, a Pap smear, and pelvic exam once in two years. You qualify for screening every 12 months if: You fall in the childbearing age group and have had an abnormal Pap smear in the last 36 months You are at high risk for vaginal or cervical cancer. You are considered to be at high risk for vaginal and cervical cancer if: You have had at least five sexual partners You became sexually active at 16 or younger You have had less than three negative Pap smears or none at all in the last seven years You have had an STI Your mother was given diethylstilbestrol (DES) when pregnant with you. Original Medicare covers pelvic exams. Breast/chest exams and Pap smears at 100 percent of the approved amount if you get services from participating providers. Who Is Eligible for Public Health Insurance? In order to be eligible for public health insurance, you must meet certain criteria. For example, in the United States, you must be a citizen or national, have a Green Card, or meet other specific qualifications. If you are not sure whether or not you meet the eligibility requirements, you can contact your local public health insurance office for more information. There are also income requirements that you must meet in order to be eligible for public health insurance. In general, your household income must be at or below a certain level in order to qualify. However, there may be exceptions to this rule depending on your circumstances. For example, pregnant women and children may be eligible for public health insurance even if their household income is above the qualifying level. Applying for Public Health Insurance If you think that you might be eligible for public health insurance, the next step is to apply for coverage. Applying for coverage can be a simple process, or it can be more complex depending on your individual circumstances. For example, if you are applying for coverage through the Affordable Care Act, you will need to provide some additional information. If you experience difficulties with the application process, or if you are denied coverage, there are options available to you. You can appeal the decision, or you can seek out other sources of coverage. For example, there may be private insurance options available to you, or you may be able to receive coverage through your job. Medicaid Income Limits In order to be eligible for Medicaid, your household income must be at or below a certain level. The exact income requirements vary from state to state, but in general, the qualifying level is quite low. For example, in California, a family of four can have an annual household income of $28,410 and still qualify for Medicaid coverage. If you think that you might be eligible for Medicaid, the best way to find out is to contact your local Medicaid office. They will be able to tell you what the income requirements are in your state, and they can help you with the application process. What If I Don’t Qualify for Public Health Insurance? If you don’t qualify for public health insurance, there are still options available to you. You can purchase private health insurance, or you may be able to receive coverage through your job. If you are having difficulty finding affordable coverage, there are resources available to help you. For example, the National Health Service Corps offers financial assistance to people who are struggling to pay for health insurance. No matter your situation, it is important to make sure that you have the coverage you need. Health insurance can be expensive, but the cost of not having coverage can be even greater. Getting public health insurance is easier than ever. Medicare and Medicaid are some of your best options. However, if you can afford it, consider getting private health insurance. It gives you more control over the quality of care you get. SHARE THIS POST