Government Health Insurance Programs and Health Insurance Regulation
Public programs
Medicare is federal health coverage for people age 65 and older, certain disabled people, and people with end-stage renal disease. Part A covers inpatient hospital care and is usually premium-free with sufficient work history. Part B covers physician and outpatient services and has a premium. Part C is Medicare Advantage, an alternative delivered through private plans. Part D covers prescription drugs. Medicare does not generally pay for custodial long-term care. Medicaid is a joint federal-state, means-tested program for low-income people and may cover long-term care. CHIP covers children in eligible families. Other programs include VA and TRICARE.
The ACA created marketplace coverage, premium tax credits, and cost-sharing reductions for eligible people. HIPAA provides portability and privacy protections. COBRA allows continuation of group coverage after qualifying events. ERISA governs many employer plans, while states regulate insurance products and producers.
Traps
Do not confuse Medicare and Medicaid eligibility. Medicare is generally age/disability based; Medicaid is income and asset based. Do not say Medicare covers custodial nursing-home care. COBRA applies to qualifying beneficiaries after specific events, not to every termination. State and federal roles overlap, so read the question’s subject carefully.
Worked rule
A 66-year-old with limited income and assets may have Medicare and also qualify for Medicaid; Medicaid can help with premiums and long-term custodial care. Medicare Advantage is still Medicare, delivered by a private plan, and does not replace the need to follow plan rules.