NC State Extension Publications

 

Health care coverage is important to your family’s ability to obtain medical attention, and it provides a level of protection against health care expenses, including paying for prescribed medicines. If you are an older adult, prescription drug payment assistance can help make healthful living more affordable. For families of all ages, it is important to understand what coverage might be available.

Employer-Based Health Care Coverage

COBRA insurance may be available from your former employer. Companies with at least 20 employees are required to offer COBRA, which allows you to purchase health care coverage under your employer’s group plan. COBRA is often expensive since you will pay your premium and the premium previously paid by your employer. However, it may be less expensive than purchasing an individual policy outside of a group plan.

Medicaid Programs

North Carolina Division of Medical Assistance offers several Medicaid programs. Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. Medicaid serves low-income parents, children, seniors and people with disabilities.

Medicaid for individuals and families

Your family’s income, the number of people in your family, and the age of your children determine if you or your children qualify. When you apply for Medicaid, your family’s monthly income is calculated by subtracting certain deductions from your gross income. Certain deductions are given for work-related expenses, child care costs and court-ordered child support or alimony. The deductions vary with each Medicaid program. Your county worker will calculate your monthly family income.

Medicaid for infants and children

Medicaid for Infants and Children (MIC) provides medical coverage for children under age 19. The income limits are determined by the family size and the age of the child(ren) for whom you are applying. There is no limit on resources and income limit tables are available at their website.

North Carolina Health Choice (NCHC) for Children

North Carolina Health Choice (NCHC) is a program designed to provide health care insurance for children in working families. Under NCHC, infants, children and teens receive free or reduced price comprehensive health care. If your family makes too much money to qualify for Medicaid but too little to afford rising health insurance premiums, your child(ren) may qualify for NCHC. Special needs children with chronic mental or physical conditions or illness may receive services beyond those listed below if the services are medically necessary (requires pre-certification).

NCHC covers hospitalization and outpatient care including the following:

  • Physician and clinic services
  • Laboratory and radiology services
  • Surgical services
  • Prescriptions drugs
  • Dental services
  • Vision
  • Hearing
  • Durable medical equipment and supplies such as wheelchairs
  • Physical therapy, occupational therapy and therapy for individuals with speech, hearing and language disorders
  • Hospice care
  • Home health care (limited)
  • Inpatient mental health services (requires pre-certification)
  • Outpatient mental health services (requires pre-certification after 26 outpatient visits per year)
  • Inpatient substance abuse treatment and outpatient substance abuse treatment (requires pre-certification)

NCHC is a North Carolina program under the Federal Insure Kids Now Program. Information is also available at 877-KIDS-NOW (877-543-7669).

Seniors' Health Insurance Information Program (SHIIP)

The Seniors' Health Insurance Information Program (SHIIP) answers questions and counsels Medicare beneficiaries and caregivers about Medicare, Medicare prescription drug plans, long-term care insurance and other health insurance concerns.

Medicare beneficiaries are eligible for the extra help if they have limited income and resources. The extra help can increase their cost savings by paying for part of the monthly premiums, annual deductibles and prescription co-payments under the new prescription drug program. The Social Security Administration estimates extra help to be worth an average of $3,900 per year.

There are many resources available to you for health care coverage. Take action today to get the coverage you and your family need.

Author:

Associate Professor and Resource Management Specialist
Agricultural and Human Sciences

Publication date: March 1, 2010
FCS-529-06

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