Each state regulates Medicaid differently, with certain optional benefits being included through expanded coverage.
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In a loose sense, you can think of Medicaid as Medicare specifically designed for people with limited resources, as both programs are meant to help cover health care expenses for people with shaky incomes. There is a bit of overlap between the two because those who qualify for Medicare can, in some cases, also qualify for Medicaid.

The DL on dual eligibility

The reason why some people can qualify for both programs (called “dual eligibility”), is that the two programs have different funding structures. Medicare functions as an entitlement program, something you pay into over time. Medicaid, however, is based on your financial need, with qualifications being determined by each state.  In Pennsylvania for example, adults with family income up to 138 percent of the federal poverty level qualify, but the qualifying level in Hawaii is 133 percent.

So this means that the 65+ crowd might also be eligible for Medicaid depending on where they live. While it might seem like grandma kicks back and rakes in the benefits, Medicare is something she’s been paying into for a long time. Medicaid fills in the gaps that Medicare can’t cover — like certain prescriptions, nursing home care and personal care. Take that, you ungrateful kids!

Optional benefits: Who needs a cavity drilled?

In addition to the three previously listed, Medicaid covers a broad spectrum of health coverage. Medicaid helps out with doctor visits, hospital expenses, lab expenses, ambulance fees, etc. Certain services aren’t guaranteed, though, because they are optional benefits.

Good thing dentures, physical therapy, prosthetics, and glasses aren’t important … because they aren’t guaranteed through Medicaid. Each state regulates Medicaid differently, with certain optional benefits being included through expanded coverage.

Who qualifies?

With nearly 60 million people on Medicaid, clearly a lot of people qualify. Since Medicaid is determined by financial standing, those receiving Medicaid benefits include a mix of children, pregnant women, parents, seniors, and others with disabilities. When the Affordable Care Act was expanded in 2014, it expanded eligibility overall and expanded coverage with federal support so even more people could qualify.

Millennials and Medicaid

One of the important things millennials should know about about Medicaid is that it can be a big help for those who are completely uninsured. With 17 percent of people aged 18-34 uninsured as of 2014, medical insurance is clearly a problem that a good chunk of millennials have.

Once millennials reach college age, many are dropped from their parents’ plans because they are no longer considered dependents. This raises premium costs and can cause the plan to become unaffordable.

The bottom line is that Medicaid isn’t just for the poor, but also the needy – in other words, those same millennials who don’t have any coverage.

So, you may actually be able to go get that nagging cavity drilled after all.


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Posted 12.02.2015 - 04:15 pm EDT