In the event that you need long-haul care and cannot stand to pay for either the authentic care you need or any type of insurance or annuity assurance, you should apply for coverage under the Medicaid program. This program gives managed care to individuals who are disabled or are 65 years old or over and have income and resources that fall underneath certain government and state limits. It is usually hard to qualify for Medicaid, however, this article can help you find out how to get Medicaid, whether you are qualified for it, and how to improve your chances of acquiring coverage.
Table of Contents
- 1 What is Medicaid?
- 2 How does Medicaid work?
- 3 What does Medicaid cover?
- 4 What does Medicaid not cover?
- 5 Medicaid eligibility
- 6 Do I qualify for Medicaid?
- 7 How to Apply for Medicaid?
- 8 What to do if you do not qualify for Medicaid?
- 9 Medicaid vs. Medicare
- 10 Advantages of Medicaid
- 11 Conclusion
What is Medicaid?
Medicaid in the United States is a federal and state program that assists with medical services costs for certain individuals with restricted income and assets. Medicaid additionally offers benefits not typically covered by Medicare, including nursing home care and personal care administrations. The fundamental distinction between the two projects is that Medicaid takes care of medical care costs for individuals with low incomes while Medicare gives health coverage to the older. There are additionally double health plans for individuals who have both Medicaid and Medicare. The Health Insurance Association of America portrays Medicaid as “a government insurance program for people of any age whose income and assets are not enough to pay for medical care.”
Medicaid is the biggest wellspring of financing for clinical and health-related services for individuals with low income in the United States, giving free health insurance to 74 million low-income and disabled individuals (23% of Americans) starting in 2017, along with paying for half of all births in the US in 2019. It is a tried and tested program that is financed by the state and the federal governments and managed by the states, with each state at present having a lot of room to figure out who is qualified for its execution of the program. Starting in 2017, the complete yearly expense of Medicaid was simply more than $600 billion, of which the federal government contributed $375 billion and states an extra $230 billion. States are not needed to take an interest in the program, albeit all have since 1982. All in all, Medicaid beneficiaries should be U.S. residents or qualified non-residents and may incorporate low-income adults, their children, and individuals with specific disabilities. Alongside Medicare, Tricare, and ChampVA, Medicaid is one of the four government-supported clinical insurance programs in the United States. Medicaid, alongside Medicare, is directed by the U.S. Places for Medicare and Medicaid Services in Baltimore, Maryland.
The Patient Protection and Affordable Care Act (PPACA, or just ACA) altogether extended both qualification for and federal subsidizing of Medicaid. Under the law, all U.S. residents and qualified non-residents with income up to 138% of the federal poverty line, including adults without dependent kids, equipped for coverage in any state that participated in the Medicaid program. Notwithstanding, the Supreme Court of the United States governed in National Federation of Independent Business v. Sebelius that states do not need to consent to this extension to keep on getting recently settled degrees of Medicaid subsidizing, and a few states have decided to proceed with pre-ACA financing levels and qualification norms.
Studies show that Medicaid improves health results, health insurance coverage, admittance to health care, beneficiaries’ monetary security, along with giving financial advantages to states and health suppliers. The Medicaid program has several parts:
- Clinical coverage through Medicaid incorporates the most widely recognized types of health care. Medicaid health benefits cover at any rate similar health care benefits that Medicare does, along with certain administrations that Medicare does not cover. Medicaid may likewise pay Medicare premiums, deductibles, and copayments for individuals who are enrolled in both programs.
- A separate portion of Medicaid covers long-haul nursing home care.
- Exceptional Medicaid-subsidized programs cover long-haul, in-home personal care. Income and resource eligibility rules for these long-haul, at-home care programs are generally significantly looser than for standard Medicaid programs.
- In certain states, a Medicaid-related program can pay part of the expenses of assisted living
How does Medicaid work?
Medicaid was made in 1965 to cover health care for Americans incapable to work. The program is voluntary. States do not need to take an interest, however, they all do. Partaking states should meet boundaries set by the Center for Medicare and Medicaid Services to get federal financing, however, they likewise have a great deal of authority over qualification and covered health care services. President Barack Obama’s health care law moved to normalize Medicaid prerequisites, explicitly so any American making up to 133% of the neediness line could qualify. Yet, that arrangement was tested and toppled by the Supreme Court. States could expand Medicaid, but at this point, they did not have to. 35 states (in addition to Washington, D.C.) did; 15 did not. Also, eligibility across states fluctuate since the Trump organization declared it would permit states to force work necessities for low-income and poor Americans getting Medicaid. At the end of the day, sorting out whether you qualify for Medicaid is significantly more testing than it was previously.
What does Medicaid cover?
Despite the fact that Medicaid does not really cover everything, it does cover a lot. The federal government necessitates that specific services be offered to all Medicaid beneficiaries. These compulsory services include:
- Family planning services and supplies
- Care provided by physicians, nurse midwives, and nurse practitioners
- Care provided in community health centers and rural health clinics
- Care provided in nursing facilities for people 21 years of age and older
- Transportation for medical reasons
- Home health care for people eligible for nursing facility services
- Laboratory and imaging services
- Early and periodic screening, diagnostic, and treatment (EPSDT) services
Nevertheless, all of the states have the option to expand on those services — and they frequently do. These optional services may include (but are not restricted to):
- Hospice care
- Case management
- Dental care (including dentures)
- Vision care (including eyeglasses)
- Mental health services
- Rehabilitation services (including physical therapy and occupational therapy)
- Durable medical equipment
- Prescription medications
- Prosthetic devices
What does Medicaid not cover?
Medicaid covers a wide scope of clinical care, however, the program for the most part does not cover certain things and services. For instance, Medicaid does not take care of professionally prescribed medication costs. Notwithstanding, the individuals who are eligible for Medicaid might have the option to get their charges paid through Medicare Part D, Medicare’s prescription drug plan. The following are some extra health-care-related costs not covered by Medicaid:
- Cosmetic surgery
- Custodial care, or assistance with activities of daily living
- Dental services
- Medical services provided outside of the U.S.
- Missed appointments
- Over-the-counter medications or supplements
- Routine or annual physical checkups
More data regarding items and services not covered by Medicare, along with exceptions to those exclusions, can be accessed through the Medicare website. The Medicaid website has a list of items and services that all states are obliged to cover, as well as a list of benefits that states may choose whether they want to cover or not.
To take part in Medicaid, federal law expects states to cover certain gatherings of people. Low-income families qualified pregnant ladies and kids, and people getting Supplemental Security Income (SSI) are instances of compulsory eligibility groups. States have extra alternatives for coverage and may decide to cover different groups, for example, people accepting home and local area-based services and kids in child care who are not in any case eligible.
The Affordable Care Act of 2010 set out the freedom for states to extend Medicaid to cover essentially all low-income Americans under the age of 65. Eligibility for kids was stretched out to at any rate 133% of the federal poverty level (FPL) in each state (most states cover kids to higher income levels), and states were given the alternative to stretch out eligibility to adults with income at or underneath 133% of the FPL. Most states have decided to grow coverage to adults, and those that have not yet extended may decide to do as such whenever. Keep in mind to check whether your state has extended Medicaid coverage to low-income adults.
The Affordable Care Act set up another approach for deciding income eligibility for Medicaid, which depends on Modified Adjusted Gross Income (MAGI). MAGI is utilized to decide monetary eligibility for Medicaid, CHIP, and premium tax breaks and cost-sharing reductions accessible through the health insurance commercial center. By utilizing one bunch of income checking rules and a solitary application across programs, the Affordable Care Act made it simpler for individuals to apply and take on the proper program.
MAGI is the reason for deciding Medicaid income eligibility for most kids, pregnant ladies, guardians, and adults. The MAGI-based approach considers taxable income and tax recording relationships to decide monetary eligibility for Medicaid. MAGI substituted the previous cycle for calculating Medicaid eligibility, which depended on the philosophies of the Aid to Families with Dependent Children program that finished in 1996. The MAGI-based procedure does not consider income disregards that shift from state to state or by eligibility group and do not take into account a resource or asset test.
A few people are excluded from the MAGI-based income checking rules, including those whose eligibility depends on visual impairment, disability, or age (65 and older). Medicaid eligibility for people 65 years old or more, or who have a visual deficiency or a disability is, for the most part, decided using the income approaches of the SSI program controlled by the Social Security Administration (a few states, known as 209(b) states, utilize certain more prohibitive eligibility rules than SSI, yet to a great extent still apply SSI systems). Eligibility for the Medicare Savings Programs, through which Medicaid pays Medicare premiums, deductibles, or coinsurance costs for recipients eligible for both the programs (frequently alluded to as dual eligibles) is found out through SSI systems.
Certain Medicaid eligibility groups do not need an assurance of income by the Medicaid office. This coverage might be founded on enlistment in another program, like SSI or the breast and cervical cancer treatment and prevention program. Youngsters for whom an adoption help agreement is going on under title IV-E of the Social Security Act are also eligible. Young adults who meet the necessities for eligibility as a previous foster care beneficiary are likewise eligible at any income level.
To be eligible for Medicaid, people should likewise meet certain non-monetary eligibility measures. Medicaid recipients, by and large, should be occupants of the state in which they are accepting Medicaid. They should either be citizens of the United States or specific certified non-residents, like legitimate permanent residents. What’s more, is that some eligibility groups are restricted by age, or by pregnancy or parenting status.
Effective Date of Coverage
When an individual is certified to be eligible for Medicaid, coverage becomes effective either on the date of application or the first day of the month of application. Advantages additionally might be concealed retroactively for up to a quarter of a year preceding the month of application, if the individual had been eligible during that period had the person applied. Coverage for the most part stops toward the month’s end in which an individual no longer meets the prerequisites for eligibility.
Do I qualify for Medicaid?
What makes me eligible for Medicaid? When talking about Medicaid eligibility, keep the following points in mind:
- Regardless of your state, you may qualify for Medicaid depending on your income, family size, disability, family status, and various other elements. Yet, on the off chance that your state has extended Medicaid coverage, you can qualify depending on your income alone.
- Enter your family size and state, and you can find out who is eligible for Medicaid if your state extended and on the off chance that you qualify for Medicaid based on your income only.
- In the event that you think you have Medicaid eligibility, you can make an account and round out a Marketplace application. On the off chance that it seems like anyone in your family meets all requirements for Medicaid or CHIP, your data will be sent to your state office. They will get in touch with you about enrollment. You can apply any season.
- In the event that you do not qualify for Medicaid, you will be told whether you can instead qualify for monetary assistance to purchase a Marketplace health plan or not. (However, except if you qualify to enroll with a Special Enrollment Period, you will need to wait until the following Open Enrollment Period.)
How to Apply for Medicaid?
The Affordable Act gives states the choice to extend their Medicaid program. Individuals with incomes of more than $16,000 can qualify in states that have extended Medicaid. In the event that you figure you might be eligible for Medicaid, it is a smart option to apply. While the principles are not quite the same from one state to another, the essential interaction for signing up can be the same.
1. Go to Healthcare.gov
Healthcare.gov is not only for purchasing a private plan. You can likewise see whether you qualify for Medicaid. You will be posed a series of questions with respect to your month-to-month income, your family size, and where you live. In light of your answers, healthcare.gov will tell you whether you may qualify for Medicaid.
2. Medicaid application form
In the event that your state is running its own Marketplace, healthcare.gov will naturally divert you to your state’s website to begin an application. Else, you can begin an application on healthcare.gov that will naturally be sent to your state’s Medicaid office for assurance on whether you qualify. You can apply for Medicaid and CHIP any season, not simply during Marketplace Open Enrollment. You can download and print the form from your state’s Medicaid site. Besides, you can likewise get it via the post office by calling 877-267-2323.
3. Gather documentation.
Your state will need to see some personal and financial data to ensure your eligibility. The details can shift from one state to another. Nonetheless, you might need to submit:
- A pay stub to prove how much you earn
- Bank statements
- A tax bill for your home
- Your Social Security number
- A copy of your birth certificate
- Other personal information
Double-check the list to ensure you have all you require. On the off chance that you have a disability, it can take more time to handle your application. You may need to wait for as long as 90 days. You may likewise need to wait longer in the event that you do not get all the administrative paperwork on schedule. Try to submit everything instantly. In the event that you do not comply with the time constraints or do not submit what is required, Medicaid may dismiss your application. At that point, you will need to apply once more.
What to do if you do not qualify for Medicaid?
On the off chance that you do not qualify for Medicaid, you can get sponsored health care through the Obamacare commercial centers during a special enrollment or open enrollment period. Americans who make somewhere in the range of 100% and 400% of the FPL qualify for an exceptional tax reduction that can essentially bring down the expense of an arrangement. Federal open enlistment for 2019 health care plans finished on Dec. 15, 2018, however, some state trades are open longer and Nevada sells health insurance throughout the entire year. Healthcare.gov, the federal trade, ordinarily opens from November 1 to December 15 every year. On the off chance that you cannot discover reasonable health care on your marketplace during the open enrollment, you have a couple of backup alternatives. These include:
- Short-term health insurance: Initially intended to forestall transient health insurance gaps, these plans are less expensive, however significantly less comprehensive than customary coverage. They do not need to cover Obamacare’s ten fundamental benefits or prior conditions. Following changes by the Trump organization, transient health plans can last from a quarter of a year to possibly three years.
- Limited benefit plans: A very small portion of the expenses related to certain “medical events”, like a doctor’s visit or ambulance services are covered by this plan. Both the number of events and dollar sums covered are capped.
- Prescription discount cards: Despite the fact that these cards will not help you pay for inpatient or outpatient care, they do assist you with getting medication at discounted rates.
- Healthcare sharing ministries: A religious option in contrast to health insurance in which people and families pay a month-to-month “sharing sum” like a health insurance premium and utilize those assets to cover ministry affirmed clinical costs.
- COBRA: The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to keep your health insurance from a prospective ex-employer for as long as 36 months (3 years), however, you are required to pay the full expense of the approach.
Medicaid vs. Medicare
Keep in mind, that there is a federal insurance program set up for Americans who are 65 years old or more. This program is known as Medicare. It likewise provides insurance for younger people with certain disabilities or sicknesses. Medicare is not free. Beneficiaries are expected to pay premiums, deductibles, and co-pays/coinsurance. Nonetheless, numerous states offer qualified low-income, poor Americans help for Medicare costs through their Medicaid programs.
Individuals frequently befuddle Medicare and Medicaid, yet the two programs are distinctive in various manners, including the accompanying.
- Medicare is federally supported utilizing taxpayer dollars and is accessible to all people age 65 and more, and to younger people who meet certain disability prerequisites. All seniors qualify for Medicare coverage, yet whether you pay for specific components of the coverage relies upon how long you paid into the Medicare/Social Security framework through payroll taxes.
- Medicaid is a federally supported program, which implies some federal tax dollars go toward assisting states with subsidizing their programs. In any case, the programs are worked at the state level, so certain components of each program might be unique.
- Qualifying for Medicaid did not depend on Social Security benefits or even age. Regardless of whether you qualify for the state-run coverage relies upon your income and assets.
In the event that somebody fits the bill for both Medicare and Medicaid, Medicare covers a large portion of that individual’s clinical benefits. In any case, there are various clinical benefits that Medicare doesn’t cover, and a state Medicaid program may cover those costs.
Likewise, Medicare now and again doesn’t take care of an individual’s doctor’s visit expenses altogether, in any event, for covered administrations. Your out-of-pocket costs as a Medicare beneficiary can incorporate Medicare expenses, deductibles, and copayments, just as the expense of some doctor-prescribed medications not covered by a Medicare Part D physician endorsed drug plan.
On the off chance that Medicare Part An or Part B covers a clinical benefit yet leaves some piece of the expense neglected, Medicaid will pay that additional sum for somebody who’s enrolled in the two projects. Somebody with both Medicare and Medicaid should enroll in a Medicare Part D arrangement to get their physician-recommended drugs covered, however, Medicaid may cover a few medications excluded from Medicare Part D plans.
Advantages of Medicaid
Medicaid has assisted with lessening the number of individuals without health insurance and the ACA has helped further. In 2013, the year before significant arrangements of the ACA became effective, an expected 44 million individuals did not have health insurance. By 2017, that number dropped down to 27.4 million. Numerous Americans would be without health insurance if Medicaid did not exist. This is so in light of the fact that low-income people regularly do not approach insurance through their positions, and buying private health insurance in the marketplace is basically not reasonable. Medicaid has given admittance to health care that has genuinely shown enhancements in the general prosperity of people who in any case would not be covered for even basic visits to the doctor’s office or prescription medication.
Medicaid is essential assistance for a great many Americans who cannot bear the cost of health insurance by themselves. In the event that you are low-income, expecting a kid, have a kid, have a disability, or are more than 65 years old, it merits applying to check whether you qualify for coverage. There is no punishment for applying — it is just about as simple as checking a box on the Health Insurance Marketplace application. In this current health emergency with COVID-19, it is particularly significant for everybody to look for help and get health care coverage if eligible.