What is Medicaid and do you need it?

Just when you feel you've finally mastered the complex web of Medicare and government-subsidized healthcare, you encounter the term “Medicaid” and realize there’s another layer to understand.

So, what exactly is Medicaid? More importantly, is it something you need? In this guide, we provide an objective, compassionate breakdown of everything you need to know about this vital safety net.

What Is Medicaid and Who Relies on It?

If you conceptualize Medicaid as a state-administered healthcare program designed primarily to assist individuals and families with limited financial resources, you are on the right track.

Today, Medicaid serves as a crucial lifeline for approximately 78.9 million Americans. This includes eligible low-income adults, children, pregnant women, seniors, and individuals living with disabilities. The program is uniquely structured: it is jointly funded by both the federal government and individual states, but it is directly managed at the state level in accordance with overarching federal guidelines.

Where Did Medicaid Originate?

Authorized under Title XIX of the Social Security Act, Medicaid was signed into law in 1965, concurrently with Medicare. Every single state, the District of Columbia, and the U.S. territories operates a Medicaid program to deliver essential health coverage to low-income populations.

Because the federal government sets baseline standards but leaves the administrative details to the states, Medicaid coverage, rules, and eligibility can look vastly different depending on where you live.

How Does Medicaid Relate to the Affordable Care Act?

When the Affordable Care Act (ACA) was enacted in 2014, it granted states the option to dramatically expand Medicaid eligibility to include individuals under age 65 living in households with incomes below 133 percent of the Federal Poverty Level (FPL).

While Medicaid and the ACA are intertwined through this expansion, they remain distinct and separate entities.

Can You Receive Both Medicare and Medicaid Simultaneously?

Yes, you absolutely can. Individuals who qualify for both programs are referred to as "dual-eligible." If you fall into this category, you can experience significantly broader healthcare coverage and dramatically lower out-of-pocket costs. Because Medicaid is state-run, you will need to proactively contact your state’s Medicaid office to understand how the two programs interact in your area and ensure you are maximizing your benefits.

For example, dual-eligible residents in states like New Jersey have the option to enroll in a Dual Eligible Special Needs Plan (D-SNP). A D-SNP is a specialized Medicare managed care plan that seamlessly coordinates your Medicare and Medicaid benefits into one comprehensive, easy-to-use package.

We know this sounds incredibly confusing. Fortunately, your state Medicaid office is equipped to help you untangle the details.

Should You Consider Applying for Medicaid?

Not everyone will need Medicaid. However, if you are struggling to manage overwhelming medical expenses and fall into one of the following categories, Medicaid is there to provide the relief you deserve:

• Adults facing low-income challenges
• Children needing pediatric care
• Pregnant women requiring maternal support
• Seniors aged 65 or older
• Individuals managing disabilities

How Can You Apply for Medicaid Coverage?

We strongly encourage you to check with your state’s Medicaid office to determine if you or your loved ones qualify. The application process will require you to provide information regarding:

• Your age
• Your current income level
• The number of dependents in your household
• Whether you are pregnant or living with a disability

There are two primary avenues to apply:

• Contact your state Medicaid agency directly. You must apply in the state where you reside.
• Complete an application online through the Health Insurance Marketplace.

How Does Medicaid Work Alongside Medicare?

If you are dual-eligible, Medicaid acts as a secondary payer to Medicare, meaning it steps in to cover the out-of-pocket copays and deductibles left behind by your primary Medicare coverage.

You have choices in how you manage this: you can remain on Original Medicare, presenting both your red, white, and blue Medicare card and your state Medicaid card at the doctor's office. Alternatively, you can choose a Medicare Advantage plan, such as the aforementioned D-SNP, to centralize your coverage under one roof.

Is There an Official Federal Medicaid Website?

Yes. You can visit Medicaid.gov, the official federal resource, which is packed with authoritative answers to the questions you likely have right now.

Do You Need Personalized Guidance on Medicare Plans That Work With Medicaid?

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