Medicaid Benefits Explained

Understanding Medicaid coverage, and how it is different from Medicare, can seem complicated to any beneficiary, whether you are new to the program or have had Medicaid coverage for years.

The types of Medicaid insurance available will vary state to state because Medicaid is run jointly between the federal government and each individual state. That means that states can choose to vary their eligibility criteria, the application methods, the costs and benefits.

Figuring out what Medicaid covers and what it does not cover offers a good start to understanding your options for medical care. For example, special services like Medicaid vision coverage or dental care might be of concern to you, especially if you already wear eyeglasses or have needed major dental work done. The prospect of long-term care is also a consideration for Medicaid beneficiaries. You should make sure you understand the options that are available to you so that when you need each type of service, you know where to go and how to obtain the coverage you need. Doing your research before you are in an emergency situation can help you to make a better decision at the time of need, without having to rush around trying to gather details.

What does Medicaid cover?

Medicaid coverage includes a list of mandatory benefits outlined by the Centers for Medicare and Medicaid Services (CMS) that oversees the program on a national level. While there are different types of Medicaid insurance, the mandatory benefits must be offered by all state as available medical services. These types of services include both preventative care and emergency treatments. Your Medicaid coverage should include hospital services, x-rays, family planning and much more. Make sure you know which benefits are included in your coverage so you can take advantage and ensure your own health and that of your whole family.

Related Article: Medicaid and Medicare

Medicaid coverage even includes transportation so that you can access your medical services no matter how far away they may be from your home or work. Knowing which benefits are offered by all states provides a baseline for you to understand your minimum benefits. There are also additional Medicaid benefits that your state Medicaid agency might offer. Find out all the details when you apply for assistance so you know exactly what is included in your coverage, since each state can offer different levels and types of insurance. Optional Medicaid benefits can include services like prescription drugs, optometry services, dental services and hospice care, among many other options.

Medicaid Vision Coverage

Medicaid vision insurance is another major concern for Medicaid applicants and beneficiaries. Whether you wear eyeglasses or you have children who require regular vision screening, you should make sure you understand exactly what vision services are covered and not covered under your Medicaid plan. Medicaid optical care is available to all children younger than 21 years old who are enrolled in Medicaid. That includes comprehensive coverage, so be sure to take advantage of those preventative screenings and regular appointments to give your child the best care possible.

Adult Medicaid vision coverage might be available to you, but that depends on your state Medicaid agency’s policies and coverage options. While increased optional Medicaid vision benefits were suggested through the Medicaid expansion efforts under Obamacare, unfortunately, not all states have opted into that expansion. That means that your state may or may not offer you the Medicaid vision services coverage that you want and need. The only way to find out about your specific coverage options is to confirm with your specific state agency.

Does Medicaid cover dental?

Medicaid dental insurance is available to all children younger than 21 years of age who are enrolled in Medicaid or CHIP (Children’s Health Insurance Program). Those beneficiaries receive comprehensive dental care and services. Dental Medicaid coverage for those children is a required service under what is called the Early and Periodic Screening, Diagnostic and Treatment (EPSDT), which is a mandatory Medicaid benefit provided by all states. Those dental services covered under Medicaid include comprehensive preventative care, meaning that regular dental appointments and examinations should be scheduled and fully covered for your children.

Understand Medicaid dental coverage for adults 21 years of age or older may or may not be offered by your state of residence. Medicaid dental care services have increased as a result of the Affordable Care Act Medicaid expansion, but not all states have accepted and implemented those increased services. That benefit is considered to be optional for all state Medicaid programs, even under the expansion of Medicaid. You should always check with your state Medicaid agency to confirm what services are covered and under what conditions you can receive that medical care.

Most states currently offer at least partial Medicaid coverage for dental care services, typically for emergency care. If you are able to get preventative care covered, be sure to take advantage of that opportunity.

About Long Term Medicaid

Medicaid long term care services are available for beneficiaries of all ages who require assistance due to chronic illness or disability. With home care, community care and institutional facility options, long term Medicaid care services offer millions of Americans the help they need on an ongoing basis. Aging adults who require additional assistance can choose from assisted living or continuing care retirement communities up to nursing home facilities with full-time medical and daily supervision.

For Medicaid eligibility for long term services, the level of care that you require has to be equal to the care a nursing facility would offer. A local medical specialist, like a nurse or a social worker, will conduct a functional assessment to evaluate your ability to complete Activities of Daily Living (ADL), including the following:

  • Bathing
  • Dressing
  • Using the toilet
  • Transferring to or from a bed or chair
  • Caring for incontinence
  • Eating

The Medicaid long term care facilities and home care options offer many levels of care, depending on your current and future needs. Most beneficiaries aim for home-care for as long as possible, which could mean a family or friend provides assistance for a while. Learning all of your long-term Medicaid care options will help you to make the best decision for your needs.

Related Article: Medicaid Eligibility

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