Do you have a dependent with special needs who may be facing loss in Tricare coverage due to aging out? Or perhaps you are caring for an elderly dependent, not eligible for Tricare and unsure of options available. This article will provide insight into Health Insurance Marketplace, Medicaid, and Medicare with links to further explore what is best for you and your dependent.
Health Insurance Marketplace
The Health Insurance Marketplace is available for individuals and families who need health insurance and are not offered health insurance through their employer. Plans are individualized based on your state of residence, and you may qualify for financial assistance to help lower the monthly cost.
Open enrollment is usually between November 1 - January 15 of each year, but if you lose your coverage during the year, you may qualify for a special enrollment period. To see what options are available, visit the marketplace website at www.healthcare.gov, or give them a call at 800-318-2596. If you are not comfortable with selecting a plan on your own, there are Health Insurance Navigators in each state available to assist with the enrollment process free of charge: Search - Local Assistance for Health Insurance Application (healthcare.gov).
Medicaid
In some states, adults 18 to 64 with an annual income below $20,121 for a household of one or $34,307 for a household of three may qualify for low or no cost insurance through Medicaid. This may apply to full-time college students who no longer qualify for TRICARE. To get more information and to see if your state has Medicaid expansion, visit the Medicaid website at www.medicaid.gov. If your state has Medicaid expansion, you can apply at the local Social Services Department or on www.healthcare.gov.
What services are covered?
• Doctor, hospital and emergency services, including primary and specialty care
• Prescription drugs
• Laboratory and x-ray services
• Maternity and newborn care
• Home health services
• Behavioral health services, including addiction and recovery treatment services
• Rehabilitative services, including physical, occupational, and speech therapies
• Family planning services
• Medical equipment and supplies
• Preventive and wellness services, including annual wellness exams, immunizations, smoking
cessation and nutritional counseling
• And more!
Children with disabilities may qualify for additional Medicaid services. It can be hard for families to know how to get services for children with disabilities. Most families get services for children from local state agencies such as the local Department of Social Services office, the Department of Medical Assistance Services (Medicaid), or the local Department of Health. Your child may be screened to determine what Medicaid waiver services they may be eligible for. Contact your local Marine Corps Exceptional Family Member Program office for more information regarding this program.
Medicare
Are you caring for an elderly dependent who needs alternate insurance options? When family members turn 65 years old or if they are adults with a disability, they may be eligible for Medicare.
If eligible for Medicare, they have the option of choosing:
(1) Standard Medicare (also known as Medicare part A and B).
(2) Adding a prescription plan to their Medicare.
(3) Adding a supplemental plan to their Medicare coverage.
(4) Choosing a Medicare Advantage plan.
For more information on how to enroll in Medicare, visit the Medicare website at www.medicare.gov, or call 800-633-4227. If you are not comfortable with selecting a plan on your own, there are State Health Insurance Assistance Program Counselors at the local Area Office on Aging or Community Services Board to assist with the enrollment process, free of charge.
REMINDER: Tricare open enrollment is November 13 – December 12, 2023. Learn more at tricare.mil/openseason.