Do you find yourself wondering whether or not you, or a loved one, is eligible for Medicaid? What does Medicaid cover, exactly?

In this Guide to Medicaid, we will go over exactly what Medicaid is, the differences between Medicaid and Medicare, what Medicaid will cover, and who qualifies for Medicaid.

Let’s get started!

Medicaid sign

 

What is Medicaid?

Medicaid is a government program, specifically designed to deliver health insurance to individuals with low income and few, or no, assets. Many people confuse Medicaid with Medicare, due to the fact that they have similar-sounding titles. However, they have entirely different eligibility benefits and requirements, as they serve different purposes.

What is the difference between Medicaid and Medicare?

Great question!

Medicare is much easier to qualify for, almost anyone over the age of 65 will qualify for it. On the other hand, Medicaid is only available to people who are over 65 years old, are blind or have a serious disability, and/or people who meet the income and resource limits.

If your parents don’t have an extremely low-income and do have some assets, they may still be eligible for Medicaid, especially if they have high medical costs. That said, it is important to become familiar with the program. This is particularly true if either, or both, seniors need long-term care – which Medicaid can cover even if the senior(s) own their home.

What you need to know about Medicaid:

Medicaid

Federally-supported, but state-administered, Medicaid is a program intended to provide health insurance to low-income, low-asset families and individuals. This includes people with certain disabilities and/or people over 65 years of age.

Who qualifies for Medicaid?

All Medicaid plans are required to provide coverage to people who have limited income and resources, and are over the age of 65. In addition, people who are blind or disabled and have low income and few assets. Considering those factors, Medicaid eligibility guidelines vary from state to state. There are some portions of your income which would not be counted when determining Medicaid eligibility, these include your car and home. To find the specific Medicaid requirements for your state online, visit the Medicaid/Medicare section of GovBenefits.gov.

It is important to realize that even if the senior(s) applying currently make more money that Medicaid income limits allow, they may still qualify if they have a substantial amount of medical bills. The reason is because most state Medicaid programs will subtract applicants’ medical bills from their residual income when determining eligibility. Once again, the details of these calculations, also known as “Medicaid spend-down” rules, vary from state to state.

If one of the seniors lives in a nursing facility while the other one lives at home, there may be more lenient income and asset rules to consider.

Can you use both Medicare and Medicaid at the same time?

In short, yes.

There are certain items and/or services that Medicaid may cover, but Medicare won’t. These include items like eyeglasses, hearing aids, and/or dental care. Medicaid can also cover Medicare premiums, copayments, and deductibles, should you meet eligibility requirements.

What does Medicaid cover?

If you qualify for Medicaid benefits, you’ll receive coverage on a variety of medical expenses. Some of these include:

  • Hospitalization
  • Outpatient care
  • Ambulatory services
  • Lab testing
  • X-rays
  • Nursing facility services
  • Dental care
  • Home health services
  • Part-time in-home nursing care
  • Certain medical supplies

Prescription drugs are covered through the Medicare prescription drug benefit. Though Medicaid may pay your Part D plan premiums and copayments, and also cover certain drugs that are not covered by the Part D plan.

One of the most significant benefits of Medicaid for many people, is that is will cover long-term custodial care within a nursing facility, as well as long term in-home care. Neither of which would be covered by Medicare.

Which doctors can we see?

To know for sure, you will have to check yourself.

Medicaid does not pay out money directly to you; instead, it sends payments directly to your healthcare provider(s). However, due to the fact that Medicaid reimbursement rates are low, some doctors don’t accept Medicaid patients. It is vitally important to determine wheth