Target Audience

Cost Structure



No cost-sharing except for non-service-connected veterans

Coverage similar to private plans

Federal employees

Coverage similar to private plans

High-risk group coverage

People at least 65 years old, disabled, people with end-stage renal disease

Coinsurance or copayment applies only after yearly deductible has been met


Low-income people, families with children, SSI recipients, pregnant womenb

States have option to impose nominal copayment for beneficiaries on basis of income


Children up to 18 years old who are uninsured, Medicaid-eligible, underinsured, American Indians, Alaska Natives

Covers cost of vaccines but not administration; providers can charge administration fee for non–Medicaid-eligible children


Children, adolescents not served by VFC program; small percentage (about 5%) used for adults

Can be used for infrastructure; annual appropriations vary


Insurance benefits for children up to 18 years old (for families making no more than $44,100/year) whose income is too high for Medicaid, too low for private insurance

Block grant program: federal match more than Medicaid match

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