What Is Medicaid? - dummies

By Patricia Barry

Copyright © 2018 by AARP. All rights reserved.

Medicaid is the national safety net of health care, paying the medical costs of people in certain groups (including seniors and people with disabilities) who have very limited incomes. More than one in five Medicare beneficiaries receives Medicaid benefits. In the official jargon, these folks are known as dual eligibles because they’re eligible for both Medicare and Medicaid services.

If you qualify for full Medicaid benefits, you should pay little or nothing for medical care, because Medicaid

  • Pays your out-of-pocket expenses in Medicare.
  • Provides more coverage than Medicare does for some services, such as extended stays in skilled nursing facilities.
  • Pays for certain items that Medicare doesn’t cover, such as eyeglasses and hearing aids.
  • Pays for long-term care in a nursing home, which Medicare doesn’t cover.
  • Qualifies you automatically for free or low-cost prescription drug coverage through Part D’s Extra Help program.

Medicaid is administered by each state, which shares costs with the federal government. (In some states, it goes by a different name — for example, MediCal in California, MassHealth in Massachusetts, and TennCare in Tennessee.) Of course, this setup means that each state has different rules for eligibility. But in general, you need to show all the following to qualify:

  • Your monthly income is under a level set by your state.
  • Your savings and other resources are under a certain value.
  • You live in the state.
  • You’re a U.S. citizen or legal resident (green-card holder).

Note that if you are married and living with your spouse, your eligibility for Medicaid is assessed on your joint income. If you are living in somebody else’s home (such as with a family member), you may still count as a “household of one” and be assessed on your own income — but only if you aren’t married or claimed as a dependent on the tax returns of the householder(s). If they do claim you as a dependent, their income as well as yours is counted, so you probably wouldn’t qualify for Medicaid.

Is there red tape? Yes; moving through the eligibility process may take a while. Can you get Medicaid one year and lose it the next? That’s possible in some circumstances. Can finding doctors who take Medicaid be harder than finding those who accept other insurance? It happens. But in general, access to care under Medicaid is as good as private insurance and often provides more comprehensive care, according to a 2013 Kaiser Family Foundation report on several studies that compared the two. In 2016, 77 percent of people who had enrolled in Medicaid through Obamacare (the Affordable Care Act) rated their coverage as good, very good, or excellent, according to a survey by the Commonwealth Fund.

To find out whether you’re eligible for Medicaid, and to get help in applying, call your State Health Insurance Assistance Program (SHIP), which provides personal help from trained counselors who are very knowledgeable about the way Medicaid works in your own state. You can find the phone number for your SHIP in Appendix A. Or contact your local Medicaid office — call Medicare at 800-633-4227 (TTY 877-486-2048) for its phone number — or go to the website that provides information about each state Medicaid program.

If you qualify for Medicaid as well as Medicare, it’s worth knowing that some Medicare Advantage plans — known as Special Needs Plans (SNPs) — specifically cater to dual eligibles. SNPs each serve a particular group of people: those with chronic health conditions, like diabetes or heart disease; those in long-term care; and those who are dually eligible for Medicare and Medicaid. The latter plans focus on coordinating Medicare and Medicaid services to help beneficiaries get the most out of both types of benefits. However, these SNPs aren’t available everywhere.