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Learn About Medicaid Costs and Coverage for Seniors

How much Medicaid covers for seniors depends on several factors. Medicaid cost estimates can vary by income, as the program is specifically for low-earning applicants. Another question you should be asking is, “What services are covered by Medicaid?” if you are considering applying for Medicaid. You must look at both the federal mandatory benefits as well as the optional benefits that may be offered by your state. In the sections provided below, you will learn more about Medicaid coverage and some of the potential fees you may be expected to pay.

The Types of Medicaid Insurance Coverage for Seniors

It is important to look at the two most common types of Medicaid insurance and the coverage options that are available on a federal and state level. The mandatory services covered by Medicaid that are set by the federal government include but are not limited to the following:

  • Hospital stays (inpatient and outpatient)
  • Home health services
  • Physician services
  • Labs and X-ray services
  • Behavioral health services

Optional Medicaid coverage determined by the state where you live can include prescription drugs, physical therapy, dental services, eyeglasses and chiropractic services. To determine what services are covered by Medicaid in your state, it is best to contact your local Medicaid office. Find out more about what medical services are mandated by the federal government in our free guide.

If you have both Medicaid and Medicare coverage, then your covered services would be a little bit different compared to what is stated above. Medicare enrollees who meet Medicaid income guidelines will receive additional covered services. For example, Medicaid coverage could include care at a nursing care facility beyond the limit that Medicare provides. Additionally, you may be able to obtain dental coverage or vision coverage that is not included in Medicare Part A and Part B.

What does Medicaid not cover for senior citizens?

It is important to understand what is and is not covered by Medicaid health insurance plans. Services not covered by Medicaid would need to be paid entirely out of pocket unless you have an additional health insurance option that does include these services.

It is important to understand that Medicaid coverage will depend upon the state that you reside in, as mentioned above. Medicaid coverage that is considered optional and not mandated by the federal government is left in the hands of each individual state. The only sure way that you will learn about optional Medicaid coverage is by contacting your local Medicaid office.

In addition to this optional coverage, the “What does Medicaid not cover?” question can still be answered to a point. While the optional coverage offered by Medicaid depends on your state, there are certain things that are not covered by Medicaid at a state level or at the federal level may include, but are not limited to:

  • Medical procedures that require prior approval, such as transplants and surgeries, that Medicaid hasn’t approved.
  • Cosmetic surgery that is not related to repairs following an accidental injury, or any surgery that is deemed cosmetic and goes beyond improving functionality.
  • Fees that are accrued from a physician office or hospital due to a missed appointment.
  • Over the counter drugs, home remedies, vitamins and food supplements, except for certain items when prescribed by your physician.
  • Items and services that have been deemed to not be medically necessary.

How much does Medicaid cost senior citizens?

As mentioned above, the question, “How much is Medicaid for senior citizens?” can be answered in a number of ways depending on your individual circumstances. Medicaid cost estimates are primarily income based. The more income you make, the more you will be likely to pay for Medicaid. These income guidelines are based upon the federal poverty level and while some may be expected to pay a small fee for Medicaid including out-of-pocket costs such as copayments and premiums, others may not have out-of-pocket costs.

Additionally, it is worth noting that if you have both Medicare and Medicaid, your Medicaid coverage will only include what Medicare will not cover. This means that if both programs cover a service, then Medicare will be the first to pay with Medicaid filling in any differences, up to your state’s payment limit. Medicaid and Medicare enrollees who have limited income and resources may be eligible for additional help, from Medicaid, to pay the costs of Medicare premiums and out-of-pocket expenses (copayments and deductibles). If you are eligible for this service, then Medicaid can effectively cut down your Medicare costs in addition to potentially providing you with more medical services. If you are considering obtaining Medicaid coverage, then this is another factor that you should examine to make an informed decision.

Download our free guide to find out more about how to enroll in Medicaid and Medicare coverage.