What Is Medicaid?

Medicaid is a federal health insurance program administered by individual states that covers one in five Americans.

Provides free or low-cost health coverage for low-income families and individuals, including eligible children, eligible pregnant women, and individuals receiving Supplemental Security Income (SSI). In some states, Medicaid covers all low-income adults below a certain income threshold.

Read on to find out what Medicaid is, how it works, its eligibility requirements, and how it compares to Medicare.

Definition of Medicaid

Medicaid is the nation's public insurance program through which low-income families and eligible individuals, such as parents, children, seniors, pregnant women, and people with disabilities, receive health coverage. Subject to federal government rules, each state administers its own Medicaid program and has the flexibility to determine health care delivery models, covered populations, and covered services.

Good health is important to everyone. If you can't afford the cost of health care now, Medicaid could be your ticket to the care you need.

How does Medicaid work?

Created in 1965, Medicaid is a federally supervised and state-run program that, along with the Children's Health Insurance Program (CHIP), provides health coverage to millions of Americans: 74.2 million in February 2021, according to the Medicaid enrollment report. .

Each state administers and monitors its own Medicaid program to determine the type, duration, amount, and scope of health services within broader federal guidelines. Federal law dictates that states grant specific benefits, while allowing each state to choose optional coverages to provide.

The chart below lists some of the mandatory and optional Medicaid benefits:

Mandatory Medicaid Benefits	Optional Medicaid Benefits
Outpatient hospital services	Clinic services
Inpatient hospital services	Prescription drugs
Home health services	Physical therapy
Nursing facility services	Respiratory care services
Physician services	Vision services
Rural health clinic services	Dental services and dentures
Laboratory and X-ray services	Prosthetics
Family planning services	Eyeglasses
Transportation to medical care	Chiropractic services

You can find the complete list of mandatory and optional Medicaid benefits on Medicaid.gov.

State Medicaid programs can also provide coverage for various types of Home and Community Services (HCBS) to help patients actively and independently live at home and in the community. Your individual needs will determine the level of support these programs provide. Some of the home health care and senior housing services provided through the HCBS programs include:

• Skilled nursing care
• Personal care like showering
• Nutrition and diet management
• Speech, physical and occupational therapy
• Meals delivered to your home

Medicaid does not provide health care directly. The vast majority of Medicaid recipients receive health coverage through privately managed health plans. For other beneficiaries, state Medicaid programs pay doctors, hospitals, nursing homes, and other care providers for the covered services they provide to eligible patients.

How to get Medicaid

Because Medicaid programs are administered by the state, eligibility requirements vary from state to state. Your eligibility for Medicaid coverage depends in part on whether the state in which you live has adopted the expanded program. In all states, you may qualify for Medicaid based on your household size, income, family status, and disability, among other factors.

In states that have an expanded Medicaid program (programs that accommodate all low-income Americans under age 65), only your income level can qualify you for coverage. Your family may be eligible for Medicaid if your current household income is at or below the 2021 federal poverty level of 100%.

The federal government sets income limits each year to define the federal poverty level for different families. Children ages 1 to 6 are eligible for Medicaid benefits when household income does not exceed 133% of the federal poverty level. Pregnant women and infants under one year of age are eligible for Medicaid with a family income that does not exceed 200% of the federal poverty level. Pregnant women are considered to be two (or more) members of the family.

Not all low-income people are eligible for Medicaid. In states that have yet to implement the Affordable Care Act (ACA) Medicaid expansion, adults 21 and older are often ineligible for Medicaid, no matter how low their income is. Exceptions include when you are pregnant, elderly, babysitting, or disabled.

Outside of the United States, citizens are not eligible for Medicaid, despite being legal immigrants. This group includes people who have temporary federal protection to live in the country for humanitarian reasons and those with temporary permission to study, work or travel in the country. Additionally, green card holders, who are legal permanent residents, cannot enroll in Medicaid for the first five years, even when they meet all the eligibility requirements.

You should still seek coverage if you need help, even if your income level alone does not qualify you for Medicaid. You may still be eligible for Medicaid in your state, especially if you are pregnant, have children, or live with a disability.

You can apply for Medicaid at any time of the year in two ways:

The Health Insurance Marketplace - You can complete a Medicaid application through the Health Insurance Marketplace. If someone in your household qualifies, your information will be passed on to the state agency, which must contact you to request it.
Your state Medicaid agency: You can also apply directly from your state Medicaid agency for coverage.

Medicaid vs. Medicare

Medicaid and Medicare are programs that provide government assistance to people who need medical assistance. When weighing your health coverage options, consider the key differences between these programs.

The main difference is that Medicaid is an assistance program that serves low-income people of all ages, while Medicare is an insurance program that primarily serves people over 65, regardless of income.

Medicare	Medicaid
Available for individuals over 65 years. People under 65 years must have a qualifying disability or end-stage renal disease.	All age groups are eligible depending on the household income, family size, or disability.
Patients pay part of the costs through deductibles, coinsurance, copays, and premiums.	Patients may have a small co-payment that varies by state.
As a federally-run program, it’s similar throughout the U.S.	The program varies from state to state, but it must remain within federal guidelines.
You can apply for Medicare during specified enrollment periods.	You can apply and enroll in Medicaid at any time.

Enjoy Watching This Video About Insurances

https://youtu.be/N5EovSvIMfE

Source: UnitedHealthcare

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