Medicare

How to Pay for Medical Care: A Guide for Americans

In this post I review how people pay for their healthcare. In the U.S., medical care financing includes employer-provided insurance, Medicaid, Medicare, the Affordable Care Act, and COBRA. Eligibility for these programs varies based on income, age, and employment status. Additional financial assistance exists through Medicare Savings Programs and nonprofit organizations, helping manage medical bills and related expenses.

This information is current as of the date of original publication or update. It may have changed by the time you read this. I invite you to fact-check what you read here.

This information is not intended for diagnosis or treatment. Before making health decisions, discuss with your physician or other qualified healthcare provider to decide what is right for you.

This content is for your “information and inspiration”, and does not imply my endorsement or recommendation.

How do you pay for your medical care?

We do not have “socialized” medicine or “universal” health care in the United States —or do we?

The government may not directly pay for healthcare but it is involved through taxes we pay and for tax deductions available for insurance premiums and certain medical expenses. Most people still pay out of pocket for at least some if not most of their healthcare.

Multiple sources confirm that at least half of the population is eligible for health insurance coverage through an employer. The rest may be eligible for coverage through one or more options discussed below.

Healthcare payment options

Government programs can help pay for medical care. Depending on the program, you may also be eligible for help with vision and dental care. Your income, age, employment status, and qualifying health issues will determine your eligibility. These programs include:

Medicaid and the Children’s Health Insurance Program (CHIP)

You may qualify for Medicaid or long-term, depending on your situation. These are both joint ventures of the federal and state governments so eligibility may differ depending on where you live. They may even have different names. In my state, Oklahoma, it’s called SoonerCare.

Unfortunately, Medicaid funding is in jeopardy due to proposed cuts in funding by Congress. Americans living in rural communities throughout the country could see their access to health care diminish if Congress changes eligibility for Medicaid or significantly reduces its federal funding.

Medicaid cuts rippling through rural America could bring hospital closures, job losses

Everyone is eligible for Medicare at the age 65 years, and sometimes younger if you have a permanent disability. It may also depend on whether or not you are still covered under an employer-provided plan.

The Affordable Care Act (ACA) / Health Insurance Marketplace

This is still sometimes referred to as ObamaCare since Congress passed the act when he was president. The current president has said he intends to end it but so far it is still law. This basically covers people who don’t have insurance through an employer or qualify for Medicare.

Premiums for marketplace plans may increase if federal subsidies are allowed to expire.

Oklahomans using ACA health insurance plans could see higher premiums, official warns

Consolidated Omnibus Budget Reconciliation Act

You may think you have never heard of this but it is better known as COBRA. (yes, pronounced like the snake.) If you have a “qualifying life event” and are no longer employed, you may be able to continue on your employer’s insurance plan.

The catch is, you have to pay for it. Paying for this type of plan can be quite expensive, but may be necessary if you have medical issues that can’t be delayed. If you will soon start a new job offering a health plan it may be worth considering this temporarily.

Learn how these programs work, find out if you are eligible, and see how to apply.

Veterans and Military Healthcare

Those currently serving in the Armed Forces and their dependents can receive healthcare through the Tricare program of the Department of Defense.

Military Veterans can receive care through hospitals and clinics of the Veterans Administration Health systems. Dependents of some veterans, usually those with service-connected disabilities may be eligible for CHAMPVA-Civilian Health and Medical Plan.

Help with medical bills beyond insurance

Medicare Savings Programs

There are 4 Medicare Savings Programs that may be able to help with Part A and Part B premiums, deductibles, coinsurance, and copayments. You’ll apply for Medicare Savings Programs through your state. When you apply, your state determines which program(s) you qualify for. Even if you don’t think you qualify, you should still apply.

Medicare Extra Help

This program can help you pay Medicare Part D costs that cover prescription drugs. Find out if you qualify for Extra Help and apply.

Financial Assistance Programs

If you still need help with medical bills after health insurance or Medicaid payments have been applied, a financial assistance program may assist you with the remaining costs. In most cases, you can apply through a doctor or hospital where you are seeking medical treatment.

Learn more about these options here.

Some non-profit medical facilities provide medical care free or at a reduced price. Patient advocacy organizations for various chronic conditions may offer financial assistance.

Programs and Resources to Help With Cancer-related Expenses
Heart disease-related expenses
National Breast and Cervical Cancer Early Detection Program (NBCCEDP) – Get free or low-cost breast and cervical cancer screenings. Eligibility for NBCCEDP is based on income, age, and whether you are uninsured or your insurance does not cover screenings.
Ryan White HIV/AIDS Program – Find help in your state or local area with HIV/AIDS medications and treatments. You may qualify for this program based on your income. And you must be uninsured, or the treatments and medications you need are not covered by your current insurance plan.
These Nonprofits Offer Financial Aid to Patients and Families

Get help paying medical bills through debt management

Despite using insurance and extra sources of help you may find yourself forced to deplete savings. You may owe more money than your budget allows you to pay regularly. You are in debt.

You may be able to get help paying your medical bills with a debt management plan. This involves a payment schedule that a credit counselor develops based on your situation.

When you pay, your money is deposited into an account with the credit counseling organization, which then pays your debt. You may be able to get lower interest rates and certain fees waived to help make it easier to pay off your medical debt.

Learn more about debt management and how it works.

The Pexels images in this post are for illustration only and do not depict real medical situations.

Exploring the HEART of Health

I hope you learned something here that helps you or someone else. Please forward it to a friend or share on social media.

In another piece, I will discuss obtaining medicines and vaccines.

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Medical stethoscope and heart on a textured background

Dr Aletha

How the President Shapes Federal Health Programs

This post, part two of a series, outlines the extensive role of the federal government in U.S. health policy, primarily through the Department of Health and Human Services (HHS). It discusses the executive branch’s involvement in health regulation, funding, and policy formation, emphasizing the significance of HHS programs and leadership roles.

This is the second post in a series helping us understand the federal government’s role in health policy in the United States. In short, its role is extensive and expensive. You can read the first post here.

The Constitution does not specifically say the government controls or provides healthcare. The Preamble hints with “promote the general welfare”.

Considering how basic and unorganized medical science was in the late 18th century, it’s not surprising they did not consider it in the plans for the new government.

I am publishing a series of posts based on

Congress and the Executive Branch and Health Policy

by Julie Jovner at KFF, an independent source for health policy research, polling, and news, an endowed national nonprofit organization.

Ms. Jovner’s article explains how the three branches of government work together, why the Department of Health and Human Services (and therefore its Secretary) is so important, and the budgeting and regulation processes.

This series is nonpartisan and objective. I made minimal edits to improve readability but retain meaning. I insert comments in parentheses to add clarity.

The photos are for illustration only and are not in the KFF article.

The Executive Branch

This post focuses on the executive branch of government, The White House including the President and his Cabinet, especially the Secretary of the Department of Health and Human Services.

The President

The executive branch carries out the laws made by Congress and operates the federal health programs, often filling in details Congress has left out through rules and regulations.

Federal workers in the health arena provide direct patient care, regulate how others provide care, set payment rates and policies, conduct medical or health systems research, regulate products sold by the private sector, and manage the billions of dollars the federal government spends on the health-industrial complex.  

Although most of the executive branch’s health policies are implemented by the Department of Health and Human Services (and to a smaller extent, the Departments of Labor and Justice), over the past several decades the White House itself (through the President) has taken on a more prominent role in policy formation.

President Donald Trump visited NIH on March 3, 2020 and toured the National Institute of Allergy and Infectious Diseases’ Vaccine Research Center (VRC) to learn about research on a vaccine for the novel coronavirus SARS-CoV-2.

Department of Health and Human Services (HHS)

Most federal health policy is made through the Department of Health and Human Services except for several key areas.

Exceptions include the

Veterans Health Administration, run by the Department of Veterans Affairs;
TRICARE, the health insurance program for active-duty military members and dependents, run by the Defense Department; and the
Federal Employees Health Benefits Program (FEHB), which provides health insurance for civilian federal workers and families and is run by the independent agency the Office of Personnel Management.

The health-related agencies within HHS are roughly divided into the resource delivery, research, regulatory, and training agencies that comprise the U.S. Public Health Service and the health insurance programs run by the Centers for Medicare and Medicaid Services (CMS). 

The Surgeon General oversees the U.S. Public Health Service (USPHS) Commissioned Corps, an elite group of over 6,000 uniformed officers who are public health professionals. The USPHS mission is to protect, promote, and advance the health of our nation.

The U.S. Public Health Service

Ten of the 13 operating divisions of HHS are part of the U.S. Public Health Service, which also plays a role in U.S. global health programs. They are: 

The Administration for Strategic Preparedness and Response (ASPR)
The Advanced Research Projects Agency for Health  (ARPA-H)
The Agency for Healthcare Research and Quality (AHRQ) 
The Agency for Toxic Substances and Disease Registry (ATSDR) 
The Centers for Disease Control and Prevention (CDC) 
The Food and Drug Administration (FDA) 
The Health Resources and Services Administration (HRSA) 
The Indian Health Service (IHS) 
The National Institutes of Health (NIH) 
The Substance Abuse and Mental Health Services Administration (SAMHSA)

CMS

The Centers for Medicare and Medicaid Services (CMS) is by far the largest operating division of HHS. It oversees not just the Medicare and Medicaid programs, but also the federal Children’s Health Insurance Program (CHIP) and the health insurance portions of the Affordable Care Act(ObamaCare).

Together, the programs under the auspices of CMS account for nearly a quarter of all federal spending in fiscal 2023, cost an estimated $1.5 Trillion in fiscal 2023, and served more than 170 million Americans – more than half the population.

KFF’s website content is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license that allows for the sharing of our information with proper attribution and without alteration.

End of KFF article

The President’s Cabinet and other Agency Heads

As you can imagine, the leadership organization of HHS is large and complex. At the top is the Secretary, who is a member of the President’s Cabinet , approved by the Senate.

Other key leadership positions, all of which are appointed by the President include

U.S. Surgeon General
Director of the CDC
Commissioner of Food and Drugs (FDA)
Director of the NIH
Director of the National Library of Medicine
Administrator of CMS

James H. Shannon Building (Building One), NIH campus, Bethesda, MD

Looking ahead-Congress

In the next post in this series, we will consider Congress’s role in overseeing these agencies and, most importantly, funding them.

“How Congress oversees the federal health care-industrial complex is almost as byzantine as the U.S. health system itself.

Jurisdiction and responsibility for various health agencies and policies is divided among more than two dozen committees in the House and Senate.”
KFF