Understanding Medicaid: Am I Eligible?

What is Medicaid?

Medicaid is a health care program for families and individuals who do not have sufficient income or resources to pay for health care.

How does it differ from Medicare?

As the names are so similar, the two are easily confused. Medicare covers seniors, and people with long-term disabilities who have exhausted their Medicaid entitlement. Medicaid is a means-tested program. It is designed to help people on a low income to pay for health care costs, regardless of age.

Medicare is a federal program, Medicaid is a joint federal and state run program. Currently all 50 states participate in the Medicaid program, but each state may set its own eligibility requirements. As a result, Medicaid eligibility requirements and provisions vary somewhat from state to state.

What does Medicaid cover?

Medicaid may cover the full cost of a variety of medical services including:

  • inpatient and outpatient hospital care
  • doctor visits
  • lab tests and X-rays
  • nursing home and home health care
  • preventative medicine

For seniors and people with a long-term disability, Medicaid may also cover Medicare expenses such as premiums, deductibles, and co-payments.

Am I eligible?

To apply for Medicare you must be a US citizen or permanent resident. To meet the low income criteria, your household income should be less than 133% of the federal poverty line. In addition, you must fall within one of the eligibility categories. These can vary state to state, but generally include:

  • low income children below a certain age
  • parents of Medicaid-eligible children who meet certain income requirements
  • low-income seniors
  • pregnant women
  • people with certain disabilities

How do I check my eligibility and apply?

To start the process, visit the government web site: http://www.cms.hhs.gov/home/medicaid.asp. There you will find an “insurance and coverage finder”, which will help you to determine if you are eligible.

Contact your local Medicaid office. They will provide the necessary paperwork for you to complete and return. They will usually need your name, address, proof of income, and bank account balances. They will also require social security numbers from you and your family members. You may be asked to provide details of additional assets. Once they have received a complete application, they will inform you of your eligibility.

If you are eligible, you will receive a Medicaid health insurance card. You can now receive your free health care benefits! Remember to call ahead to make sure that your provider accepts Medicaid, and always carry your card with you.