A Medicaid card allows individuals to receive medical care and prescription drugs at approved providers. Once approved, beneficiaries receive their Medicaid ID card in the mail.
This card contains information, which can include an individual’s primary care provider and medical home. The primary care physician (PCP) is the doctor the beneficiary visits for general medical care. If a beneficiary requires care beyond what the PCP offers, PCP issues a referral to a specialty care provider.
Medicaid recipients must sign the card when they receive it, and store it in a safe location to prevent anyone from gaining access to the card. Individuals who knowingly misuse their Medicaid card IDs by allowing others to use them may lose their benefits. To use a benefit card Medicaid recipients must verify that the provider accepts Medicaid. If a beneficiary needs care before he or she receives the card, he or she may use the eligibility letter as proof of insurance.
When it comes to how to get a new Medicaid card, recipients will receive their IDs in the mail, once approved for the program. The appearance of the Medicaid card, and the information on it, may vary, depending on the state in which the cardholder resides. However, all cards have basic information about the beneficiary, which includes the name of the primary care physician (PCP) for the recipient and medical home. The PCP is the provider the beneficiary uses for general care. When a beneficiary needs specialty care, the PCP is the one who issues the referral.
Related Article: How to Find Medicaid Providers
Beneficiaries must immediately sign the card and store it in a safe location. It is important for cardholders to protect their cards to help prevent identity theft, misuse of information and Medicaid fraud. Individuals who knowingly misuse their Medicaid cards, such as allowing others to use them, may lose their benefits.
Program participants may use the card for Medicaid for general doctor visits, such as routine checkups and preventive care. However, not all providers accept the card. Therefore, program participants must check with their provider before making an appointment.
Individuals who do not currently have a PCP may contact the member services number found on the Medicaid insurance card. A representative can help the beneficiary find a list of providers who accept the insurance. When making an appointment, beneficiaries must first verify that their providers accept the card. If an individual does not verify this information, he or she may get a bill for the services Medicaid does not cover.
If a beneficiary already has a PCP, he or she should verify if the provider accepts the Medicaid card before making any future appointments. You can determine this information by calling the office and asking if the provider accepts the insurance program. Individuals may also call the member services number listed on the back of the card to determine if a PCP accepts Medicaid. If an individual has a PCP before becoming eligible for Medicaid, he or she must ensure the provider accepts the insurance. If not, the beneficiary may still be able to get care from the PCP until a new provider is located.
There may be times in which a beneficiary needs care beyond what is offered by a PCP. In that case, the PCP must make a referral to a specialty care provider. Medicaid cardholders must contact the specialty care provider to verify if the service is , and if the provider accepts Medicaid.
A Medicaid beneficiary may receive care before a card arrives in the mail. The procedures may vary by state. However, the beneficiary may present his or her eligibility letter – in place of the Medicaid card –to the provider during their visit. Many providers may accept the letter as proof of insurance.
Medicaid card holders are requested to use their regular PCP for non-emergency or non-life-threatening matters. However, in an emergency, cardholders should seek care at the nearest emergency facility. They must present their cards during their visits. By law, providers must give emergency care to individuals with a Medicaid card until the patient’s condition is no longer life-threatening. The rule applies regardless of the individual’s insurance or Medicaid status.
Although prescription drug coverage is an optional benefit with a Medicaid card, all states currently offer the coverage. When submitting a prescription request, beneficiaries must provide their Medicaid ID cards as proof of insurance. In most states, the program only covers the generic version of a drug, unless the doctor has obtained authorization for the brand name. Also, the card may not cover certain medicines, such as weight loss products, cough and cold medications (which can be purchased over the counter) or immunizations other than the influenza vaccine. Beneficiaries may be required to pay small copayments for their prescriptions. Medicaid recipients should consult with their pharmacists to see what medications are covered under the program.
If an individual has other insurance, such as Medicare, the primary insurer pays, first. The Medicaid card is always the last resort, and will only pay for the portion not covered by the primary insurer.
In most states, if a person qualifies for a benefit card for Medicaid, his or her child is eligible for either Medicaid or the Children’s Health Insurance Program (CHIP). Once the state approves a minor for Medicaid, the state issues the dependent a separate Medicaid card. Therefore, when making appointments, beneficiaries must present the dependent’s card if the appointment is for the dependent.
Each state has different procedures for requesting a replacement Medicaid card. Beneficiaries must call their state Medicaid agencies to report a lost Medicaid card. Some states allow individuals to request a replacement online, by phone or through the mail. The agency may require verification of the beneficiary’s information before issuing a replacement Medicaid card. Make sure to replace your lost ID card in a timely manner, so you have no problem using your Medicaid benefits no matter the circumstance.
Related Article: Medicaid Related Programs