Medicaid is available to low-income families and individuals, as well as children, people with disabilities, pregnant women and senior citizens. This insurance program receives federal funding and oversight, but it is primarily run by state agencies. Therefore, you must apply for assistance through the Medicaid agency in the state where you live.
Because each state is in charge of running its own Medicaid program, keep in mind that the specific requirements may vary depending on where you live. Furthermore, some states may use a different name for this program. For example, Medicaid is known as “Medi-Cal” in California. Learn more about qualifying for Medicaid and applying for coverage in the sections below.
What are the Medicaid requirements?
To qualify for Medicaid, you will need to meet certain requirements. Even though each state runs its own Medicaid program, many of the basic requirements are the same no matter where you live. To qualify for coverage, you generally must:
- Meet the income requirements in your state.
- Be a resident of the state where you are applying for help.
- Be a U.S. citizen or qualified non-citizen.
In some cases, you might automatically be eligible for coverage. For example, you are already qualified for Medicaid if you receive assistance such as Supplemental Security Income (SSI). Furthermore, in some states, you can qualify for Medicaid based on your income alone. However, depending on where you live, your eligibility might be based on factors such as your age, disability status or whether you are pregnant.
States may also extend eligibility to applicants who are considered “medically needy” even if they do not meet the other program requirements. For example, an individual with significant health care needs might qualify for coverage even if his or her income exceeds the limits of the program.
Note: Many states have expanded their Medicaid programs to cover more people. If you have been denied Medicaid coverage in the past and your state has expanded Medicaid, you may consider reapplying to see if you meet the new requirements.
What if I am denied Medicaid coverage?
There are many other health insurance options to choose from if you are not eligible for Medicaid. In some cases, you can still qualify for tax credits or other types of health care savings if you do not meet the income requirements for Medicaid. There are a variety of lower-cost plans on the private marketplace to choose from.
How to Apply for Medicaid
There are two main ways to apply for Medicaid coverage. First, you can submit a form directly to the Medicaid agency in your state. Second, you can apply for coverage by using the federal Health Insurance Marketplace. If you apply on the Marketplace, your information will be sent to your state’s Medicaid agency.
Because each state has its own Medicaid program, the exact application methods and steps will vary depending on where you live. States may allow you to apply online, in person, by phone or by mail. Regardless of the method you choose, you usually have the option of applying for yourself or designating an authorized person to apply on your behalf.
When you fill out an application, you will need to provide basic details on yourself and each member of your household who wants Medicaid coverage. This can include details such as:
- Date of birth.
- Income and employment information.
- Social Security Number (SSN).
Unlike other types of health insurance, there is not a specific window of time in which you must submit an application for Medicaid. In other words, there is no open enrollment period for this type of insurance. Instead, you may apply for Medicaid at any time.
If you are approved for Medicaid, your coverage will start based on the date that you submitted your application. However, it may take several weeks for your application to be processed. With that in mind, it is in your best interest to apply for Medicaid as soon as you need coverage.
How much does Medicaid cost?
If you receive Medicaid, it is important to understand the out-of-pocket costs you may need to pay. In some situations, you may need to pay the following:
- A premium, which is a monthly fee that you pay in order to have health insurance.
- A deductible, which is a certain amount of money you must spend on health care before your insurance will help cover the cost.
- Coinsurance, which is the amount you must pay out-of-pocket for services once your deductible amount has been met.
- A copayment, which is a fee you must pay before you can receive certain medical services.
You may be exempt from paying these out-of-pocket costs in some situations. For example, people in vulnerable groups, such as pregnant women or people with disabilities, are usually exempt. These costs will also vary depending on your situation. In any case, Medicaid costs are generally lower than those for private health insurance plans.
What does Medicaid insurance cover?
Medicaid covers a wide variety of health care needs. Some types of coverage are mandated by law, while other services are optional. The exact types of coverage may vary depending on the state you live in. No matter where you live, Medicaid is required to cover services such as:
- Inpatient and outpatient hospital care.
- Home health care.
- Laboratory work and X-rays.
- Family planning and pregnancy care.
- Physicians’ services.
States may choose to provide additional services such as dental care, prescription drugs, physical therapy or optometry services. However, these coverages are not mandated by federal law.
How to Use Medicaid and Find Providers
When you are approved for Medicaid, you will receive an insurance card. This card will usually need to be shown before you can receive medical care.
Many doctors, hospitals and pharmacists accept Medicaid insurance. In some cases, you may even find that your current provider accepts this type of coverage. To find more information on providers that accept your insurance, you may contact your state Medicaid agency. There are many resources for finding providers that you can use with your insurance.