Reliable health care coverage is essential in modern times. Repeated periods of medical and economic volatility have become the norm in today’s world. This emphasizes both the importance of having health insurance and the challenges associated with affording it.
Fortunately, Medicaid insurance is available to help qualifying U.S. residents obtain the health insurance they need. Continue reading to learn what Medicaid is and how to successfully apply for it.
Apply for Medicaid (and Get the Most from Your Coverage)
Medicare and Medicaid are the two primary government-funded healthcare programs in the U.S. today. Both programs share the common goal of providing reliable health insurance to qualified U.S. residents in need. Qualification requirements and coverage benefits between the two are quite different, however. Continue reading to learn about the following Medicaid topics:
1. Medicaid 101 (What Is Medicaid?).
2. Difference between Medicare and Medicaid.
3. Medicaid eligibility and qualification requirements.
4. Apply for Medicaid following these steps.
5. Using Medicaid (getting the most from your benefits).
6. Medicaid diabetes coverage.
7. Children’s health insurance program.
Medicaid was created in 1965 alongside its peer-program Medicare. Its purpose was and still is to provide free or inexpensive health care insurance to U.S. residents with qualified serious disabilities. Since its inception, however, Medicaid has expanded to also provide coverage to U.S. residents experiencing financial hardship.
The program is funded by the federal government, which at times creates conflicts due to divided political and socio-economic belief systems across the country. While some states seek to continue expanding Medicaid’s reach, other states simultaneously attempt to reduce its benefits and increase qualification restrictions. For now, and as it did during harshest phases of the pandemic, Medicaid continues to function as intended.
In fact, new enrollment increased by ten million people (nearly fourteen percent) between February 2020 and January 2021. Despite any conflicts and attempts to dismantle the program, Medicaid literally saved countless lives in the midst of the most challenging times the U.S. has seen in recent times.
Medicare and Medicaid each function differently to achieve similar goals, albeit also for different demographics of people. Similarities between the two programs include the provision of health insurance coverage to people with qualifying serious disabilities. Both Medicare and Medicaid are also funded by the U.S. federal government, although this is where the similarities begin to diminish.
Qualified tax paying U.S. residents are automatically enrolled in Medicare when they turn sixty-five years old. Medicare benefits are divided into four primary categories (plans). Some plans are free, while others require members to pay certain expenses out-of-pocket. The program is both funded and operated by the Centers for Medicare & Medicaid Services, which is an agency of the federal Department of Health and Human Services (HHS).
Medicaid does not have an automatic enrollment option. Medicaid is primarily purposed to provide health insurance coverage to individuals and families experiencing financial hardship. The program is still funded by the federal government, but operation is handled jointly between both state and federal government agencies. Every individual state has legal permission to both regulate and determine the availability of Medicaid benefits, enrollment requirements, coverage features, additional services and the rejection of multiple aspects of the program.
Medicaid eligibility is determined primarily based on the household income of each applicant. The U.S. federal poverty line is used as a qualifying threshold. For example, applicants whose household income is 138 percent or is less than the federal poverty level (FPL) are likely to qualify.
The number of people living in your home impacts your eligibility. All household income is tallied cumulatively per applicant. The resulting cumulative household income amount is also a determining factor pursuant to whether your Medicaid plan provides partial or full coverage. Partial coverage results in enrollees paying for certain expenses out-of-pocket.
Each state is permitted to create and enforce customized program standards. This includes your state choosing what doctors and medical facilities you are permitted to use. Ultimately, what this truly means is each state decides what medical facilities and doctors are permitted to receive payments from the Medicaid program.
This also includes your state either tightening or loosening qualification requirements. Fortunately, most U.S. states permit pregnant women, senior citizens and children to all receive Medicaid benefits regardless of the state’s stance on the program overall.
Your Medicaid qualification status is possible to verify online prior to submitting your application. This is a convenient feature, which prevents wasting time if your household income level or other factors would otherwise disqualify you from successfully enrolling.
Simply visit the HealthCare.gov website to initiate your pre-qualification status process. Different states give their Medicaid programs different names, therefore some research is required to determine where to submit your application. The application process is also different in each state.
Regardless of state, you must prepare your income verification documents and information prior to applying for Medicaid. Proof of income (commonly in the form of the most recent two year’s tax returns) and employment status is required for each household member. Proof of identity and citizenship or resident status is also required for every member of your household. If you are a senior applying for nursing facility status you are generally expected to have dumped the most recent five years’ worth of assets to qualify.
Why does Medicaid require this? Medicaid requires what is known as the “five-year look lookback” because assets and income must be severely limited to qualify for coverage, especially coverage involving long-term care. Applicants with disabilities or debilitating medical conditions are also required to provide supporting statements from doctors, medical records and additional supporting documentation.
Medicaid options are available as two broad categories. Community Medicaid is vital to enrollees with limited or no other coverage options. The nursing facility program is another category, which as stated above, requires comprehensive planning and preparation for approval.
Optional and federally-mandated Medicaid coverage categories are also available. Vision and dental services are available in some states but not others. Inpatient and outpatient hospital services are available in all states, however. Medicaid physical therapy is also an optional coverage, included by some states and rejected by others.
To get the most from your Medicaid benefits, be certain to read all documentation provided to you once enrolled. Call your provider and ask any questions you have without hesitation. Keep organized track of your medical records. Abide by all rules, laws and regulations pursuant to income qualifications and other eligibility requirements. Research different insurance providers as well, to find out which ones offer you the best coverage and customer service.
Diabetes is a serious chronic illness, which potentially leads to heart disease, stroke, hypertension, blindness and more. Medicaid covers some or all of the expenses of anti-diabetic drugs for qualified enrollees. Medicaid diabetes coverage plans also include payments for some or all of the following:
- Diabetes screening tests.
- Medicare Diabetes Prevention Program enrollment.
- Diabetes self- management training.
- Diabetes supplies and equipment.
The Children’s Health Insurance Program (CHIP) is a joint federal and state-government sponsored health insurance program. Children up to nineteen years of age potentially qualify. Household income is the largest determining qualification factor.
CHIP also provides coverage for pregnant women ins certain states. Each state has permission to create its own regulations and guidelines pursuant to CHIP qualification requirements and benefits. Cost-sharing up to five percent of your annual household income is common in the form of deductibles, coinsurance and more. Cost-sharing for well-baby and well-child visits and certain other services is not permitted, however.