A Beginner's Guide to Medicaid: Everything to Know
Medicaid is a giant in the U.S Healthcare scene. As of 2020, 66.8 million people are enrolled across all 51 states.
Despite its popularity, many people still find it hard to understand. The following guide to Medicaid will tell you everything you need to know.
Let's dive in.
What is Medicaid?
Medicaid is a state-operated, health-care program for low-income families. It's funded at both the state and federal levels. In 2019 Medicaid accounted for 16% of United States spending on healthcare.
Medicaid, Medicare, and Social Security Benefits often get mixed up though the programs are distinct. Here are some key differences.
Is federally funded using taxpayer dollars.
Is an insurance program.
Is available to all citizens age 65 and older.
Is available for younger individuals meeting disability requirements.
Whether you pay for parts of the coverage depends on how long you paid into the Medicare/Social Security system through payroll taxes.
Is a federally aided program.
Is an assistance program.
The programs are operated at the state level, program specifics may differ state to state.
Qualifying for coverage depends on your income and resources.
Social Security Benefits (SSI)
You pay a percentage out of every paycheck.
Not dependent on age.
Goes into a general fund, not a personal account.
Credits are earned as you work and pay taxes.
Only replaces some of your income.
It is possible to receive all of these benefits. If you qualify for Medicaid and Medicare, Medicare will cover most of your medical expenses. What it doesn't cover, a state Medicaid program usually will.
If you find Medicare A and B don't end up paying medical bills in full, Medicaid will foot the rest of the bill if you are enrolled in both programs.
Your Guide to Medicaid
As we mentioned, Medicaid programs are different in each state. To determine what Medicaid covers in your state, visit this website.
One of the biggest questions people have is 'what does Medicaid cover?' While there is some variance, every state is expected to cover the following services with no co-payment, Medicare A and B should also cover the following:
What Does Medicaid Cover?
Medicaid should cover inpatient hospital care, short-term skilled nursing, or rehab facility care. It should cover doctor services, including lab work and x-rays.
It should cover any outpatient hospital or clinic care, short-term in-home healthcare (provided by an agency).
And lastly, it should cover ambulance rides and any prescription drugs for those not covered by Medicare.
Possible Coverage
Some states may opt to cover additional services for a nominal co-pay amount. These services might include eye exams or hearing tests and any associated needs, like glasses or hearing aids.
Basic or intensive dental care could be covered. Any preventative screenings may also be covered, including chiropractic care.
Physical therapy beyond what Medicare offers might be covered. As well as prescription drugs not covered by Medicare and over the counter medicines or vitamins.
What Doesn't Medicaid Cover?
There are some services Medicaid typically won't cover at all. You may find yourself paying out of pocket or relying on secondary coverage for anything routine, like a physical.
Over the counter, meds or supplements may not be covered. Any sort of custodial or respite care may not be covered. As well as any missed appointments, if there are fees associated you will likely be responsible to pay up.
Medical services you may receive out of the country won't be covered. Including any major dental surgeries or cosmetic surgeries.
Supplemental insurance, either private or through Medicare, may help to fill in coverage gaps.
Medicaid Enrollment and Cost Sharing
Unlike private healthcare, Medicaid offers rolling registration. That means you can apply anytime during the year.
States are constantly working to make Medicaid better and may occasionally change their criteria on who qualifies and make options for coverage broader.
If you applied and didn't qualify before, chances are if you tried again you may be eligible. This is especially true if you're pregnant, have children, or have become disabled.
Medicaid is meant to provide access to healthcare to those who may not otherwise be able to afford it. That said, there are some set rules around how much of what service or prescriptions is covered.
This handy guide goes into great detail and may be of use in figuring out the benefits of Medicaid.
Who Accepts Medicaid?
Medicaid does not reimburse medical providers at the same rates as private insurance. For that reason, some providers choose not to accept patients who only covered by Medicaid and/or Medicare.
It's important to clarify with a provider before your visit whether or not they accept Medicaid or Medicare.
Some Medicaid recipients will opt for coverage under a health maintenance organization (HMO). These put some restrictions on what provider you can see but can also eliminate a monthly premium, and any co-pay for Medicaid covered services.
If you are unsure about whether a physician is in-network for Medicaid or Medicare, check out this handy search tool. You'll find an extensive list of providers for everything from primary care to dental.
How Do I Apply?
The first step is figuring out if you are eligible. To do so you have a few options.
You can fill out an application on the Health Insurance Marketplace. If you or anyone in your household is eligible, you will be contacted.
They will also let you know if you are eligible for any marketplace health insurance plans. Some are more affordable than you might think. You can create an account to fill out an application here.
Another option is to apply through your state Medicaid office.
Or, you can leave it to the highly trained professionals at MedicareWise. Agents are available to answer all your questions and help you through the process.
Get The Help You Need Now
Growing old is enough of a challenge without having to wade through pages of complex medical jargon and manuals.
We hope that our guide to Medicaid has given you insight into what options are available to you and how to find them in your state.
Our licensed insurance agents are standing by to answer any remaining questions you might have to get you on the path toward coverage today. Our plans are personalized to meet your specific needs, and each person is treated with the utmost care and dignity.
We look forward to providing yo stellar service.
