What is Medicaid and do you need it?

Medicaid is a government health program that is designed to provide coverage for people who meet specific criteria. Learn how and if it is connected to the Medicare program.

2 mins read

Just when you think you are starting to know the intricacies of Medicare and government-subsidized health care plans, you hear the word “Medicaid” and realize you still have some learning to do.

So what is Medicaid? In this article, we’re going to tell you what you need to know.

What Is Medicaid and Who Uses It?

If you think of Medicaid as a form of Medicare that is administered at the state level, mostly for people who lack economic resources, you won’t be far off.

Medicaid currently provides health coverage to 78.9 million Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. The program is funded jointly by states and the federal government, but it is administered by states, according to federal requirements and rules.

Where Did Medicaid Come From?

Authorized by Title XIX of the Social Security Act, Medicaid was signed into law in 1965 alongside Medicare. All states, the District of Columbia, and the U.S. territories have Medicaid programs designed to provide health coverage for low-income people.

Although the Federal government established certain parameters for all states to follow, each state administers its Medicaid program differently, resulting in variations in Medicaid coverage across the country.

What Is the Connection Between Medicaid and the Affordable Care Act?

When it was passed in 2014, the Affordable Care Act gave states the authority to expand Medicaid eligibility to individuals under age 65 in families with incomes below 133 percent of the Federal Poverty Level (FPL).

So although there is that tie-in between Medicaid and the Affordable Care Act, they are not the same thing.

Can You Be Getting Both Medicare and Medicaid Assistance at the Same Time?

Yes, you can. And people who are enrolled in both Medicaid and Medicare may receive greater healthcare coverage and have lower out-of-pocket costs. But because Medicaid is essentially a partially Medicare-funded program that is administered by the state where you live, you will need to contact your state’s Medicaid office to learn how to take part in both programs and whether you should.

One example? New Jersey residents who have both Medicare and Medicaid, known as “dual eligible,” can enroll in a Dual Eligible Special Needs Plan (D-SNP, pronounced “dee-snip”). A D-SNP is a special kind of Medicare managed care plan that coordinates all covered Medicare and Medicaid managed care benefits in one health plan.

That’s confusing, right? But your state Medicaid office can help you sort it all out.

Should You Apply for Medicaid?

You might not need Medicaid. However, it is there to help cover your health care expenses if you fall into one of these categories and are having a challenging time paying your medical care:

  • Adults with a low income
  • Children
  • Pregnant women
  • People who are age 65 or over
  • People with disabilities

How Can You Apply for Medicaid Coverage?

Check with your state’s Medicaid office to see if you or your family members are eligible for benefits. You might qualify. The state office will ask you questions related to:

  • Age
  • Income level
  • Number of people in your family
  • If you are pregnant or have a disability

There are two ways to apply for Medicaid:

Does Medicaid work with Medicare?

Yes, if you have Medicaid, Medicaid second to Medicare for any health services that result in a copay to you.

You can either stay in Original Medicare and use your red, white and blue Medicare card alongside your Medicaid card. You can also sign up to a Medicare Advantage plan, including special plans called ‘Dual-eligible’ Special Needs Plans (D-SNP) which centralize and coordinate your Medicare and Medicaid benefits into one plan.

Does the Federal Government Have a Medicaid Website?

Yes, it does. It is Medicaid.gov, and it has answers to the questions you are probably asking about Medicaid right now.

Need Personalized Help Understanding Medicare Plans that Work with Medicaid?

At CoverRight, we’re here to help you find the right Medicare coverage based on your needs. Reach out today and start finding the best Medicare plan for you.

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Barry Lenson

Barry’s is an experienced writer who's most recent book projects have included "The Digital Health Revolution" and "Connecting Health Care," for which he served as writer and editor for the author Kevin Pereau. Barry’s own books include the Amazon.com self-help bestseller "Good Stress, Bad Stress." Barry writes blogs for Tortal Training, Ingage Consulting, Specialty Metals Smelters and Refiners, and other clients.

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