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Understanding Medicaid: What Does Medicaid Cover?

Understanding Medicaid: What Does Medicaid Cover?

In the complex and frequently changing landscape of health care in the United States, Medicaid stands out as a vital program. Since 1965, it has provided essential coverage to millions of low-income individuals and families. Alongside Medicare, Medicaid serves as a lifeline for those who may otherwise struggle to afford health care services.

Though Medicaid exists to help those who need it, navigating the specifics of what it covers and does not cover can be daunting. This article highlights the basics of Medicaid coverage, shedding light on its benefits and limitations.

The Basics of Medicaid

Medicaid offers health care coverage to individuals and families within certain income and asset guidelines. However, what many individuals may NOT understand is that are rules in place to allow for planning and preservation of assets when applying for Medicaid benefits. Medicaid provides a wide range of medical services, including doctor visits, hospital stays, prescription drugs, and preventive care. Medicaid is a joint federal and state program, so each state has the flexibility to administer the program differently within broad federal guidelines. However, each state is required by federal law to provide Medicaid’s mandatory benefits.

The eligibility criteria for Medicaid benefits vary from state to state and may relate to factors such as income, household size, disability status, and age. Seniors and people with disabilities may need to meet additional criteria.

Seeking out an experienced Elder Law attorney in your state is essential to understanding the rules and navigating the process. The following benefits are provided as a guideline only.

What Medicaid May Cover in Your State:

Doctor Visits and Preventive Care

Medicaid should cover visits to primary care physicians, specialists, and other health care providers for preventive services, including vaccinations, screenings, and wellness exams.

Hospital Services

Medicaid coverage for inpatient and outpatient hospital care may include emergency room visits, surgeries, and medically necessary treatments.

Transportation to Medical Care

Medicaid generally covers the costs of emergency and non-emergency transportation to and from medical appointments and services that are covered by Medicaid.

Prescription Drugs

Medicaid provides coverage for a wide range of prescription medications deemed medically necessary by health care providers. However, coverage may vary depending on your state’s specific guidelines.

Laboratory and Diagnostic Services

Medicaid may cover laboratory tests, diagnostic imaging, and other medical tests necessary for diagnosis and treatment.

Mental Health and Substance Abuse Services

Mental health services may be eligible for Medicaid coverage. These may include counseling, therapy, psychiatric care, as well as treatment for substance abuse disorders.

Long-Term Care

Medicaid provides coverage for long-term care services. This includes care in nursing facilities and home health services for eligible individuals who require assistance with daily activities. Individuals may qualify for these services because of age, disability, or chronic illness.

Dental and Vision Care

Coverage for dental and vision services varies by state.

What Medicaid May NOT Cover:

  • Cosmetic Procedures
  • Experimental or Investigational Treatments
  • Non-Emergency Medical Transportation
  • Out-of-Network Providers
  • Certain Prescription Drugs
  • Routine Foot Care (unless it is medically necessary).

Medicaid plays a crucial role in ensuring access to health care for millions of vulnerable individuals and families nationwide. And though Medicaid covers many services, exclusions and limitations could result in unexpected costs or denials of coverage.

Consequently, it is of the utmost importance that you contact an experienced elder law attorney at Zacharia Brown to ensure that you understand the scope and limitations of Medicaid coverage in your state so you can make informed decisions about health care needs and costs.