How Public Health Insurance Works: A 2025 Guide
Public health care insurance is invaluable in the healthcare system, providing affordability in coverage for millions of people. For those who are unacquainted with it, the workings of public health insurance may seem rebarbative. This guide will teach you how public health insurance works, how it functions, and what you need to understand about your options in 2025.
Since most public health insurance is government-financed to serve those unable to access private health insurance, it ensures that millions of people get the medical care they deserve, regardless of their financial status. Among other public health insurances offered in the United States, we have Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), as well as the insurance available through the Health Insurance Marketplace.
Medicare: A Guide for Seniors and Disabled Persons
Medicare is a federally funded health insurance program for individuals aged 65 years and older, as well as younger individuals with specific disabilities. It has several parts, each covering certain services:
- Part A: Hospital insurance covering inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Part B: Medical insurance that pays for doctor visits, outpatient care, and some preventive care.
- Part C: Also known as Medicare Advantage, this offers both Part A and Part B coverage, plus additional benefits like vision, hearing, and dental care.
- Part D: Covers prescribed drugs, obtained through private insurance companies that contract with Medicare.
Medicare is accessible to all eligible individuals. In 2025, select beneficiaries will benefit from additional coverage options such as new preventive services and mental health benefits.
Medicaid: Insurance Coverage for Low-Income Individuals and Families
Medicaid is a federal-state program that provides health coverage for low-income individuals and families. Medicaid eligibility is based on income, household size, and medical requirements. The program covers a wide range of services, including doctor visits, hospital care, prescription drugs, and emergency services.
Under the Affordable Care Act, many states have expanded Medicaid, enabling more low-income people to qualify for coverage. Medicaid also includes mental health services, long-term care, and in some cases, dental and vision care.
Children’s Health Insurance Program (CHIP)
The CHIP program provides coverage for children in families that earn too much to qualify for Medicaid but cannot afford private health insurance. Similar to Medicaid, CHIP covers doctor visits, vaccinations, emergency care, and prescriptions. The program is available to children up to the legal age of 19, with eligibility varying by state.
Health Insurance Marketplace: A Resource for Affordable Coverage
The Health Insurance Marketplace is a service that allows people to shop for, compare, and enroll in health insurance plans. Created by the Affordable Care Act (ACA), the Marketplace ensures that people who do not qualify for Medicaid or Medicare still have access to coverage. In 2025, the Marketplace will provide basic health benefits such as emergency services, maternity care, and mental health services, among others.
Marketplace plans are divided into four metal categories: bronze, silver, gold, and platinum. Each category offers different levels of coverage. Bronze plans have lower premiums but higher out-of-pocket costs, while platinum plans have higher premiums but lower out-of-pocket costs. Depending on your income, you may be eligible for subsidies that reduce your monthly premium.
Steps in Joining Public Health Insurance
Enrollment in public health insurance varies by program. For programs like Medicare, you enroll during open enrollment periods. The Health Insurance Marketplace also has an open enrollment period, but you can qualify for a Special Enrollment Period if there are changes in your life, such as marriage, moving, or loss of other health coverage.
For Medicaid, enrollment is open year-round as long as you qualify. The process typically involves applying and providing financial information to determine if you qualify.
FAQ
What is public health insurance?
Public health insurance is government-provided health coverage designed to offer affordable healthcare to people who qualify based on age, income, or medical condition.
How do I know if I am eligible for Medicaid or Medicare?
Medicaid eligibility is based on income and family size, whereas Medicare is available to those aged 65 or older, or individuals with disabilities. You can check your eligibility by visiting the government’s website or contacting your state’s Medicaid office.
Can I apply for public health insurance all year round?
Medicaid has year-round enrollment, but Medicare and Marketplace plans have open enrollment periods each year unless you qualify for a Special Enrollment Period due to life changes.
Do public health insurance benefits cover mental health services?
Yes, both Medicaid and Medicare cover mental health services. The Health Insurance Marketplace also offers plans that cover mental health care.
