Many individuals today cannot afford health insurance, mainly those in lower income brackets. Tens of millions of Americans rely on Medicaid for this insurance, including those who can’t work because they are disabled and individuals on Medicare who can’t afford the payments. The government determines the benefits offered and who may receive this coverage. 

Understanding What Medicaid Covers

Medicaid varies by state, so the services covered differ. When applying for Medicaid, a person must understand what the insurer will pay for and what remains their responsibility. Medicaid will cover any diagnostic and screening tests ordered by a doctor, medical appointment fees, and hospital stays. Family planning, prescription medications, long-term care, and nursing home services are also included in the services covered by the insurer. 

When enrolled in this government plan, children receive additional services. They will receive the services mentioned, and the insurer will pay for eye doctor visits and prescription glasses. Medicaid also covers mental health services. 

Medicaid Eligibility

Medicaid eligibility rules vary by state. The federal government requires states to cover certain groups, but each state may then choose to expand coverage to include more people or increase the amount of coverage. Income plays a significant role in who qualifies for this government-funded medical insurance. 

Every state has a cut-off based on income. Individuals whose income falls below a certain level may qualify, although asset limits come into play in some states. Nevertheless, people shouldn’t assume they won’t be eligible if their income exceeds this level. Medicaid has exceptions for specific groups. 

Individuals with high medical bills might need assistance paying co-pays and any amounts that exceed the policy limit. Medicaid can often help these people with the additional expenses. This is referred to as the spend-down process, and a Medicaid enrollment specialist can help a person determine if they qualify after deducting the medical bills from their income. 

Immigrants and Medicaid

Immigrants wonder if they are eligible for Medicaid. Again, each state makes this determination. Some states will allow lawfully present immigrants to apply for Medicaid if they meet income guidelines after a short waiting period. Other states require them to be in the country for five years before applying. 

Certain states allow low-income immigrants to receive healthcare through a state-funded program. They can receive this care regardless of their immigration status. Qualified refugees, on the other hand, don’t need to wait to apply for Medicaid. They may do so without waiting for five years. 

Applying to Medicaid

Once a person is approved for Medicaid, they receive an ID card. This card must be presented at all medical appointments or when receiving a prescription. Some states use private health plans for Medicaid, and the applicant may be required to choose a health plan if they live in one of these states. 

Medicaid coverage is retroactive. If the applicant was eligible for Medicaid during the three months prior to the application being submitted, the insurer will pay any medical expenses incurred during that period. However, some states are not required to provide this retroactive coverage, so the applicant must ask whether these expenses will be covered. 

Managed care plans might be used to provide Medicaid services. Today, a majority of beneficiaries are enrolled in one of these plans. The applicant must learn whether their state uses managed care plans to offer Medicaid coverage and join one of the plans if it does. 

Applying for Medicaid can be confusing. Feel free to ask questions about the process and application. This healthcare coverage is meant to better the health of those who couldn’t afford coverage otherwise, so people should use it. Once the application process has been completed, those with Medicaid will also have peace of mind knowing their medical expenses are covered.