A state and federally-funded health insurance program, Medicaid is designed to help low-income adults, children, pregnant women, and seniors get the medical care they need. To be eligible for benefits, recipients must meet the required income level and family size.

Eligibility

Income-based eligibility is determined using the federal poverty level, which is updated annually. Since 2014, when the Affordable Care Act passed, Medicaid eligibility has expanded. In addition to placing income requirements on recipients, states may charge enrollees a premium, along with copayments, deductibles, and coinsurance for benefits. Children and pregnant women are excluded from many of these fees, but all applicants must meet state and federal requirements concerning residency, immigration status, and documentation of U.S. citizenship.

Coverage

While Medicaid varies from state to state, each must meet certain mandatory federal minimum requirements. The program pays for basic inpatient and outpatient hospital services, nursing and home health care, laboratory and x-ray services, pediatric care, and necessary medical equipment. Many states have expanded the mandatory federal minimums to include benefits for physical, occupational, and speech therapy, optometry, podiatry, dental and vision care, chiropractic services, hospice care, and more. Benefits are provided through Medicaid that are not covered by Medicare, such as personal care and homemaker services. Medicaid covers out-of-pocket expenses associated with Medicare, like premiums, deductibles, and coinsurance.

Dual Enrollment

Dual eligibility in both Medicaid and Medicare is common, and millions of seniors receive benefits from both programs. As a Medicare recipient with low income, Medicaid may be able to help pay for out-of-pocket expenses associated with Medicare. Medicaid often covers treatment and services not typically covered by Medicare, such as prescription drugs, eyeglasses, and hearing aids. If you qualify for Medicaid benefits, you may be eligible to receive retroactive coverage that can help pay for medical debts you incurred up to three months before applying.

References:

https://www.medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/seniors-and-medicare-and-medicaid-enrollees.html

https://www.medicaid.gov/medicaid-chip-program-information/by-topics/cost-sharing/cost-sharing.html

https://www.medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/eligibility.html

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