Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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Medicaid: A Comprehensive Guide

Medicaid was initially designed to provide long-term nursing home care for the elderly. Over time, it has evolved into a local and federally funded program that provides medical care for low-income families, those with disabilities, and pregnant women.

In addition, Medicaid is the division that is responsible for community services for people with disabilities that allows them to live independently and learn life skills as well.

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The government-run Medicaid program is managed individually by each state. What this means is that even though the federal government funds each program, they allow each state to set their own qualification and coverage criteria.

This is why you might qualify for Medicaid in one state and not qualify in another, even if your income and family size doesn’t change.

Some of the things that each state determines for itself are:

  • Eligibility requirements
  • Recertification methods
  • How often recertification occurs
  • What is covered under the plan
  • Rate of payment for services rendered

Often, children of low-income families will qualify for Medicaid while their parents do not. This applies to children under 18, although is some states, if your child is still a full time student Medicaid will cover them until they are 21.

It is very difficult for adults to get on Medicaid, even if they are low income. The income eligibility requirements in some states are as low as $1,000 a month in income and assets. In addition, some states will not allow you to receive Medicaid if you own your own car or home.

Medicaid will provide coverage for your past medical bills if you qualify for Medicaid and can’t pay your previous bills. This can be a lifesaver for many people who have thousands of dollars in bills but don’t know how they are ever going to be able to pay them.

When you apply for Medicaid, you will need to provide some or all of the following items:

  • Birth certificate or federally approved ID that shows proof of citizenship
  • Social security number, if you have one
  • Pay stubs for past 4 to 6 weeks or your previous year’s W2 if you don’t have any paystubs
  • Current bank statement
  • Current health insurance policy
  • Current life insurance policies
  • Asset list including house, car, stocks, bonds, etc…

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What does Medicaid cover?

Some Medicaid services will vary from state to state, such as the cost of braces. Some states pay for this under Medicaid while most don’t. However, there are also some services that every person on Medicaid, no matter what state they live in, can expect to receive. These are:

  • Well and sick doctor’s visits
  • Prescription medications, although there will be a requirement for generic first
  • Inpatient and outpatient hospital services
  • Emergency treatment
  • Emergency ambulance services
  • Preventative dental care
  • Medical equipment
  • Physical therapy
  • Hospice
  • Immunization
  • Home health services
  • Vision screenings and glasses
  • Hearing screenings and hearing aids
  • Psychiatric care
  • Counseling

In some states, your doctor determines the best care for you, including operations and such. In others, your doctor may have to get permission to provide you with certain types of services. It simply depends on how your state regulates this service.

In addition, your Medicaid may cover part or all of your services depending on your financial status. In some cases you will be required to pay a co-pay because the Medicaid department believes that at your income level you will be able to pay for some, but not all, of the costs out of pocket.

When you have Medicaid, if you can’t afford the copay at the time of your office visit, your doctor isn’t allowed to refuse you care. This is the agreement he/she made when they agreed to accept Medicaid. This doesn’t mean that you never have to pay, only that they will have to bill you for the services. In the future, they can drop you as a patient if you consistently don’t pay but, once they accept your appointment, they have no choice but to provide you with the care that you need.

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Why don’t all doctors take Medicaid?

This is a touchy subject as of late because with the onset of the 2010 US health care bill, more and more doctors are actually refusing to accept Medicaid. There are various reasons for this, but the bottom line is all about money.
Medicaid determines just how much they will pay for each of the services that you receive when you to a doctor. In order for that doctor to bill for your services, they have to hire a Medicaid insurance expert to handle the filing of those claims. Medicaid is notoriously slow in paying claims in many states. What’s more, they are known for changing billing codes or requiring billing code changes time and again because they don’t feel like a service should be billed under the code that it was originally assigned.

What’s more, Medicaid is cheap; it’s that simple. If you were to go to a doctor’s office and have a check up, it would cost you about $90. This covers the cost of the doctor’s time, the nurse or nurses that helped you as well as the office staff that checked you in, the rental of the office, etc. etc. Medicaid, however, might pay $30 for that same visit, which doesn’t come close to covering the necessary fees.

That is why you will often find offices that accept Medicaid often book their appointments at 10-minute intervals and they are often backed up. They want to make some money, while providing treatment for their patients but they have to book 3 times as many patients a day in order to accomplish this.

If you live in a state where you get excellent care while on Medicaid, then you probably live in a state where the payment for services is higher than normal. In these states you will find that a majority of doctors accept Medicaid. The truth is that, in any state, if every doctor accepted Medicaid, then the cost would balance out and the doctors that do accept Medicaid wouldn’t be hit as hard when they receive their payment from Medicaid.

Who should apply for Medicaid?

Any low income family should apply for Medicaid. However, here are some other people who should consider applying for Medicaid:

  • Pregnant women
  • Elderly 65 or older
  • Blind people
  • Disabled people
  • Someone in need of nursing home care
  • Terminally ill individuals
  • Women with breast or cervical cancer
  • Families with children under the age of 18

Even if you aren’t a low-income family, if you don’t have enough money to cover the cost of health insurance, then you should apply for your children. Most states have alternative programs for families that don’t qualify for Medicaid and they will automatically be enrolled in the program they qualify for when you apply for Medicaid. These programs take a lot of stress off of families who feel as if they can’t provide care for their children.

You can find out what your state requires by visiting your state’s Food Stamp or Health Care websites. You can also find more information on the Health & Human Services’ Medicaid Web site.

If you don’t qualify for Medicaid and you are trying to find cheap medical insurance, try our free quote tool right now and find health insurance that you can afford!

Enter your zip code to compare health insurance quotes for Medicaid now!