What does Medicaid Cover and What can it be Used For?
Unlike Medicare, which is an insurance program that is solely offered by the federal government, Medicaid is offered by the state, in conjunction with the federal government. As a result, when compared to Medicare, what is covered by Medicaid is more likely to vary from state to state. However, there are a number of mandatory healthcare costs that are covered by the program and this gives the program a degree of predictability as far as what it covers is concerned.
Coverage mandated by federal law
While states generally have a degree of control when it comes to the type of coverage that one gets under Medicaid, there are services that are required to be included in the coverage by federal law. Generally, anyone who qualifies for Medicaid receives coverage for both outpatient and inpatient hospital services.
For pregnant women, coverage for counseling services relating to quitting tobacco use is offered. They also get coverage for expenses relating to services received from a certified nurse and pediatric practitioner, midwife services, and services relating to a recognized or licensed freestanding birth center. The coverage that they get also extends past the delivery date, that is, if any complications occur within 60 days after giving birth, any services relating to those complications are covered by it.
If you have to be transported to a facility in order to receive medical care, costs relating to these services are covered under this program. And so are X-rays, laboratory services, early screening and diagnosis, family planning, and physician services. The insurance also offers coverage for expenses relating to a rural health clinic, home health, and nursing facility services.
As far as dental services are concerned, Medicaid offers limited coverage. It only offers coverage for any dental work that is deemed medically necessary especially in cases of emergency. However, for children who are enrolled into the program, they get more coverage for dental services as this falls under Early and Periodic Screening, Diagnostic and Treatment (EPSDT).
For children, Medicaid generally offers wider coverage. The benefits that they get from the Children’s Health Insurance Program (CHIP) and Children’s Medicaid include coverage for lab tests, X-rays, medical supplies, mental health care, prescription drugs, office visits and regular checkups, pre-existing conditions, and special health needs treatment. Eye health services like glasses and eye exams are also included in the coverage that the insurance plan offers.
Coverage advantage for people with Medicare
Sometimes, people can qualify for both Medicaid and Medicare. For such people, the question is always whether there is an advantage to having both, and whether you are even allowed to enjoy the benefits of both programs. Essentially, people who qualify for coverage under both programs are allowed to enjoy their benefits. In fact, it is usually beneficial to get both mainly because there are things that Medicaid covers, that are not generally covered by Medicare. This is especially with regards to coverage that is offered at the discretion of a state.
Most cases where having coverage from both programs comes in handy relate to costs that are partially covered by Medicare. For example, Medicare offers limited coverage with respect to a number of prescription drugs. In such a case, having Medicaid can help by sometimes covering the part that Medicare does not cover. This is something that can go a long way towards lowering the healthcare expenses that you may have to cover for with your own money.
What does Medicaid Cover? Limitation on Medicaid Coverage
While the coverage that is offered by Medicaid is wide, it is still limited. Since different states offer a significant portion of Medicaid coverage at their discretion, the coverage that one gets is usually limited by where they are located. Also, where you get the medical services matters because generally, any health services that you receive in a facility that is not within the United States is not covered by the program.
Services relating to custodial care, missed appointment costs, supplements, or medications that are offered over the counter, and routine physical checkups are also typically not covered by Medicaid. And while some states offer coverage for dental services, this is something that is not typically offered.
Another area that is not covered relates to cosmetic surgery. Therefore, anyone who is interested in having weight loss surgery may have to seek coverage elsewhere.