What Does Medicaid Cover? The Answer May Surprise You

Medicaid is a national health coverage system in the United States that is administered by the states with joint funding from them and the federal government. It differs from other health insurance because of strict eligibility guidelines and different benefits. People nationwide use Medicaid, but you qualify based on income, disability and family size. There were 64,699,741 people enrolled in Medicaid in the U.S in 2019.

However, rising demands on healthcare and a growing population that is aging mean the number of enrolled people will continue to grow in the future. At the same time, staffing shortages are increasing demand for skilled administrators and other personnel because healthcare makes up almost 11% of total national employment. Medicaid administration offices often struggle to keep up with this demand.

Despite the large number of people who have Medicaid in the U.S., many are not aware of everything this health insurance covers. Here are some of the common services and items that Medicaid covers.

Medicaid Coverage 

Medicaid coverage can vary from state to state. In general, it covers a large range of services that a person may need during their lifetime, such as physical exams or surgeries. However, some people are not aware of the following services, which are covered by Medicaid.

Addiction Services

Medicaid provides coverage for a variety of screenings and tests, such as alcohol screening and counseling. In general, Medicaid covers most aspects of drug and alcohol dependency recovery like treatment. However, not all rehabilitation facilities will accept Medicaid as payment, so you must search for rehab locations that do.

Medicaid will also pay for most addiction services other than alcohol treatment. You usually do not have any co-payments for addiction services in most states. However, some states mandate co-payments but set an out-of-pocket maximum. Coverage can include initial screenings, intervention, medications, counseling, detox, inpatient care and outpatient visits.

Alcohol and addiction are not the only screenings that Medicaid covers because it will pay for depression screening. This mental health condition can also affect pregnant and postpartum women. Medicaid is required to cover a woman’s depression screening as part of a well-child visit and to pay for subsequent diagnostic and treatment services.

Part of Medicaid’s goal is to have healthy residents and to prevent future medical problems, such as those that stem from tobacco use. This includes counseling for quitting tobacco and payment for treatments. If you have a doctor’s prescription, Medicaid will pay for prescription medications as well as over-the-counter products, including nicotine gum or patches. Some states even offer to send free tobacco-quitting products to your home.

Preventive Tests

Preventive tests and screenings are important for catching problems before they become more serious. Usually, an early diagnosis results in faster treatment and the prevention of complications. Medicaid covers many preventive tests for people, such as breast cancer screenings.

This includes breast cancer screenings and prevention services without co-payments. Screening mammography is covered at least every two years and once a year for women with a high risk of breast cancer. Genetic testing and counseling for mutation of genes that increase the risk of breast cancer are also covered. In addition, preventive medications for some women with high risk are also included.

Bone density tests are another type of screening that Medicaid covers for some individuals. Medicaid will not cover bone mineral density measurement for people who have a low risk of osteoporosis. In general, the health insurance covers the screenings for women over the age of 65 and men over the age of 70. There are some exceptions, such as individuals who have low bone mass because of other conditions like cerebral palsy.

Medicaid also covers glaucoma tests for people who have a high risk. Usually, this test is done during an annual eye exam. Medicaid will pay for eyeglasses, including lenses, frames and repairs.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is part of Medicaid and covers certain tests for children under 21. This includes a variety of screenings, such as mental, physical, developmental, dental, vision and hearing. The goal is to catch problems early in children and provide treatment.

For instance, a child can receive hearing services through Medicaid that include diagnosis. Treatment, such as hearing aids, would be covered by the insurance. This may also include follow-up visits to check if the hearing aids are working properly or if they need to be replaced. Hearing aid batteries are not covered, so you will have to provide them and pay for them.

It is important to remember that coverage will depend on the state you live in and other local variables. Medicaid is not the same in every state, so some services may not be available for free. You can contact the office where you applied for Medicaid to receive more information and ask questions about coverage.

Sandra Johnson

Sandra Johnson

Sandra Johnson was a few years out of school and took a job as a life insurance agent in California, selling coverage door-to-door for Prudential. The experience taught her about the technical components of insurance and its benefits for individuals and society, as well as the misunderstandings people often have about insurance. She has over ten years’ experience in the insurance industry, having worked as both a Broker and Underwriter, assisting clients across a broad range of industries. At Insurance Noon, Sarah diligently gathers all the required information and curates up pieces to provide meaningful insurance solutions. Her personal value proposition is to demonstrate a genuine interest in always adding value for clients.Her determined approach to guiding clients has turned her into a platinum adviser to multiple insurers.