Health coverage in the United States is mainly characterized by the existence of Medicare and Medicaid. Millions of citizens rely on these coverage programs, but to qualify, they must meet certain eligibility requirements. What happens to those who do not meet these requirements? Fortunately, the United States has more health coverage programs funded by federal and state funds.
These include the Children’s Health Insurance Program (CHIP) for children and pregnant women; the Affordable Care Act (ACA), which allows citizens with moderate incomes to access federal or state markets. Federally Qualified Health Centers (FQHCs) provide care even if you cannot afford to pay for medical care; The Program of Comprehensive Care for the Elderly (PACE) provides special care for those seniors who want to live at home, and assistance for prescriptions through GoodRx, which reduces the price of medications by 90% or even 100%.
All these assistance programs are available to those citizens in need who meet certain requirements. Although the vast majority of Americans have Medicaid or Medicare, not everyone is eligible, so it is necessary to have other sources of assistance to care for the entire population when it comes to a medical emergency or health issue.
Alternative programs to Medicaid and Medicare
Medicaid is a federal and state program in the United States that helps citizens pay for necessary medical services. It is intended for a group of people who meet low income and resource requirements. The main difference between Medicaid and Medicare is that the former provides coverage to individuals and families, while the latter does so to people over 65 and people with disabilities, regardless of their income.
- The Children’s Health Insurance Program (CHIP). It offers coverage to children whose families earn too much to qualify for Medicaid but who cannot afford private insurance. In some areas, it also covers the needs of pregnant women. Despite being a federal and state program, each state has the freedom to implement it in its own way.
- The Affordable Care Act (ACA). This is aimed at individuals with middle incomes, so they can access cheaper health plans.
- Federally Qualified Health Centers (FQHCs). These centers, along with local health centers, can be found throughout America. They provide medical coverage such as dental care or doctor visits, and the patient pays what they can afford. They serve even if the person has no resources to make any type of payment.
- The Comprehensive Care Program for the Elderly (PACE). This program helps those over 55 who need specific care. These individuals choose to live at home, so PACE, along with Medicaid, provides transportation services, rehabilitation, or home services to assist them.
- Prescription assistance through GoodRx. The cost of medications is out of reach for the vast majority of citizens. This is why sites like GoodRx offer them 90% cheaper. Additionally, some pharmaceutical companies have Patient Assistance Programs (PAPs) through which medications are provided for free to beneficiaries.
Why are these programs so important?
As the U.S. Department of Health and Human Services states, no one should be denied access to medical care due to age or income. However, theory is always very different from practice. Although millions of citizens rely on Medicare and Medicaid programs, unfortunately, they are not enough. Not only that, but a large percentage of the population falls outside the eligibility criteria, and that does not mean they do not need help to cope with the high costs of medical expenses in the United States.
Being aware and remembering the existence of complementary state and federal assistance programs is very important. Despite the role that Medicaid and Medicare play, the existence of community clinics, discounts on prescriptions, and subsidized plans provides financial and resource relief for many people in the country.
New measures to access Medicaid in 2026. Does it affect your state?