Medicaid is one of the largest government programs. It covers over 80 million individuals including retirees, the disabled and low-income households. Since Medicaid is such a large, expansive program, it's not always easy to understand what it does. This article looks to answer "Is Medicaid health insurance?" along with how it works.
What Does Medicaid Cover?
Medicaid provides health care for a few key different groups. First, it covers people with disabilities. Medicaid also helps retirees pay their Medicare premiums and out-of-pocket costs. Medicaid could also cover their nursing home expenses. It's an alternative for those who run out of money and don't have their own long-term care insurance policy.
Last, Medicaid covers the health care of low-income adults and their children who would struggle to afford their own health insurance policies. This includes financial assistance for pregnant women as well as for people taking care of other family members.
What Is Health Insurance?
Healthcare.gov defines health insurance as "a contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium." A key feature is that you're making some sort of monthly premium payment to an insurance company that then agrees to cover your future health care costs.
You could buy health insurance as an individual or get it through your work, with your employer helping to cover the cost. You can also buy health insurance to coordinate with government programs like Medicare. For example, when you sign up for Medigap, you get a private insurance plan that covers the out-of-pocket costs not handled by Medicare. In other words, it helps fill the gaps.
Is Medicaid Health Insurance?
Medicaid is a government-run health care program. While it pays for health care bills in a number of different ways, it technically isn't health insurance according to the Healthcare.gov definition. The reason for this is you can't just go out on your own and buy Medicaid coverage whenever you want by paying premiums.
To qualify and receive Medicaid coverage, you must meet the income, disability and residency requirements set by the program. While state governments could charge premiums to help cover costs, the program is primarily financed by taxes.
How Does Medicaid Change State by State?
Medicaid is a joint federal and state government partnership. The federal government provides money to every state in the country to help finance their programs. The federal government also sets certain rules and guidelines that each state must follow, like they must cover children below the age of 18 in families earning below 138% of the poverty line (less than $31,781 for a family of three in 2022.)
Then, each state has the flexibility to run Medicaid its own way within these federal requirements. The eligibility rules, benefits and out-of-pocket costs depend on where you live. For example, whether single healthy adults over 21 without children qualify depends on where they live. In Massachusetts and California, they might qualify depending on their income, but in Texas and Louisiana, they wouldn't.
How Can You Learn More About Using Medicaid?
Since Medicaid rules change depending on the state, a good starting resource would be your state's Department of Health. They could provide information on their eligibility rules and the different programs available in your area. Your department should provide a phone hotline as well as local offices where you can go to ask questions and enroll.
You can also get information from the federal government through Medicaid.gov. You can call the federal government toll-free hotline at 877-267-2323 or email them at Medicaid.firstname.lastname@example.org.
To apply for Medicaid health care coverage, you can go through either your state's Medicaid agency or you can apply through the Healthcare.gov website. As part of the enrollment process, they will tell you if you're eligible. For other benefits like long-term care coverage, you'd need to apply with your state's Medicaid agency.
Navigating Medicaid can feel a little overwhelming given all the different rules state by state. For more information, consider meeting with a local insurance agent. They can help you determine whether you could qualify for government benefits and, if so, which ones. In addition, they could discuss whether you could get your health care needs covered with private insurance as well.