What is Medicaid?

The Medicaid insurance program offers medical coverage to low-income Citizens throughout the country. However, each state actually operates its own program under federal guidelines.

State programs can vary slightly in eligibility requirements and benefits offered, but the overall Medicaid program must still follow the national standards set by the government. Understanding these requirements and benefits can be of great use to anyone who might qualify for assistance.

Medicaid benefits include a variety of medical coverage options, depending on your needs and your eligibility qualifications. The plans offered by each state government have to include the basic levels of coverage required by the federal government. Beyond that basic level of coverage, some states have also opted to expand their programs and to offer coverage to more residents. Get all the details about how Medicaid works and whom it covers, in the appropriate sections below.

How does Medicaid work?

Adult Medicaid is just one part of the whole Medicaid system that offers health care coverage to many residents. Since this type of insurance is not based on age, it differs from the Medicare program. Medicaid health insurance can cover any of the following groups of people:

  • Adults
  • Children
  • Pregnant women
  • Elderly adults
  • People with disabilities

The Medicaid program is available to millions of residents who have a low income and it is often considered to be the last resort to ensure health care coverage needs are met despite any financial barriers. Depending on your state of residence, your income alone might even determine your eligibility for Medicaid services. States that do not use that eligibility system will have multiple factors that determine your entry into the program, with income being just one of them.

Medicaid benefits include a long list of mandatory coverage set by the federal government, plus a potential additional benefits list set by your state. If you have Medicaid and require medical attention, your medical provider will be compensated directly by the program. Some states use private insurance companies for their Medicaid health coverage.

Under some Medicaid plans, you might need to also pay a co-payment to cover some costs of your medical services. This varies, so it is important that you always understand your own Medicaid plan and any payment requirements that you might have.

About Medicaid Plans

Medicaid insurance helps low-income individuals and families who qualify to cover the costs of both preventative and emergency health care. No matter where you live, Medicaid program plans are required to cover a list of services that have been deemed necessary by the federal government. Some of those benefits include the following:

  • Inpatient and hospital services
  • Physician services
  • Laboratory and X-ray services
  • Family planning and nurse-midwife services
  • Certified Pediatric and Family Nurse Practitioner services
  • Transportation to medical care

Medicaid coverage varies state by state, since the program is run as a joint federal-state effort. Each state can choose how it will offer Medicaid services. Therefore, you must contact your specific state-run Medicaid program in order to ask about eligibility factors, application requirements and benefits options. The following list includes some other optional services that might be included in your Medicaid coverage:

  • Prescription drugs
  • Physical and occupational therapy
  • Podiatry services
  • Optometry services and eyeglasses
  • Dental services and dentures
  • Prosthetics
  • Chiropractic services
  • Hospice care

Knowing exactly what your state Medicaid plan covers and what it does not cover can save you from getting a surprising bill for medical services received. Be sure you understand Medicaid costs and coverage offered through your specific state plan before you schedule an appointment.

Medicaid vs. Medicare

Medicaid and Medicare are often confused because their names are similar and their primary goals are similar. Knowing the differences can help you to determine which program is best for you. Medicaid health insurance and Medicare both offer medical coverage, but how they are administered is very different.

Medicaid insurance offers assistance to low-income individuals and families of any age. If you have Medicaid coverage, you will likely not pay at all for covered medical expenses, unless there is a small co-payment required. Medicaid is run as a joint effort between the federal and state or local governments, so it does vary by location in what recipients receive for benefits.

Related Article: Medicaid and Medicare

Medicaid and Medicare differ in the populations they serve. To qualify for Medicare, you must be at least 65 years of age and you will pay part of your medical costs through deductibles and monthly premiums. Taxpayers pay into the Medicare system during their working years, which is how medical costs are later paid after reaching the age of 65 years old. Medicare is run on a federal, national level by the Centers for Medicare and Medicaid Services (CMS) with no state-level variations.

National and State Medicaid Programs

The national Medicaid program is the basic standard by which all state programs must provide health coverage to recipients. If you qualify for Medicaid insurance, you will at least receive those national-level services that are guaranteed.

However, each state also determines its own Medicaid program options. Your state might offer additional benefits beyond the basic requirements set by the federal government. Your state might also have different eligibility standards, making it either easier or more difficult to qualify, depending on your personal circumstances. Some states accept your income level as a sole deciding factor, while others include a variety of qualifications to determine your eligibility. Those states that take only your income into account have elected to expand Medicaid in an effort to offer health care coverage to more residents in need of assistance.

Additionally, another important Medicaid insurance detail to consider is the potential limitations of the coverage for your particular needs. Not all Medicaid plans are the same. Some plans offer limited health care coverage and only pay for the following services:

  • Family planning
  • Emergency Medicaid
  • Tuberculosis services
  • Outpatient hospital services

If you have limited Medicaid coverage, you can go to the Health Insurance Marketplace to see if you qualify for comprehensive coverage through Medicaid or by purchasing a Marketplace insurance plan at a lower rate.

Related Article: Medicaid Benefits Explained

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