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Medicaid Health Insurance

Doctors reviewing the x-rays of a patient with pill and looking glass on the sides

What is Medicaid?

It is health insurance for low-income families, pregnant women, some disabled people, individuals and children who qualify. Although the federal government sets certain standards for this program, each state administers its own version.

The federal government and the states pay for Medicaid jointly. Individuals and families must meet certain income or disability thresholds to be eligible. Children who meet eligibility guidelines receive care from the Children’s Health Insurance Program (CHIP). Also paid for by federal and state funds, CHIP is designed to provide health coverage for children of families whose income is too high to qualify for Medicaid, but who cannot afford private coverage.

At Freeway, we want to help you find the healthcare you and your family needs. Freeway’s licensed and bilingual agents can help you navigate through the Medicaid maze.

What Are the Benefits of Coverage?

Medical coverage includes the most common forms of healthcare, including at least the same healthcare services that Medicare does, as well as some services that Medicare doesn’t cover. It also pays Medicare premiums, deductibles, and co-payments for people who are enrolled in both programs. It is not always free health plans—states have the option to charge premiums and to establish out of pocket spending (cost-sharing) requirements for enrollees.

What Do Medicaid Services Cover?

Although the coverage in individual states is different, there are some mandatory federal requirements that must be met in order to receive federal matching funds. Required services include:

  • Inpatient hospital services
  • Outpatient hospital services
  • Prenatal care
  • Vaccines for children
  • Physician services
  • Nursing facility services for persons aged 21 or older
  • Family planning services and supplies
  • Rural health clinic services
  • Home health care for persons eligible for skilled-nursing services
  • Laboratory and x-ray services
  • Pediatric and family nurse practitioner services
  • Nurse-midwife services
  • Federally-qualified health-center (FQHC) services and ambulatory services
  • Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21

Doctor checking the heartbeat of boy with his family in the doctors office

Who’s Eligible?

Each state sets its own Medicaid eligibility guidelines. The program is geared towards people with low incomes, but eligibility also depends on meeting other requirements based on age, pregnancy status, disability status, other assets, and citizenship.

States must provide these services for individuals who fall under certain categories of need in order for the state to receive federal matching funds. For example, it is required to provide coverage to certain individuals who receive federally assisted income-maintenance payments and similar groups who do not receive cash payments. Other groups that the federal government considers “categorically needy” and who must be eligible include:

  • Individuals who meet the requirements for the Aid to Families with Dependent Children (AFDC) program that were in effect in their state on July 16, 1996
  • Children under age 6 whose family income is at or below 133% of the Federal poverty level (FPL)
  • Pregnant women with family income below 133% of the FPL
  • Supplemental Security Income (SSI) recipients
  • Recipients of adoption or foster care assistance under Title IV of the Social Security Act
  • Special protected groups, such as individuals who lose cash assistance due to earnings from work or from increased Social Security benefits
  • Children born after September 30, 1983 who are under age 19 and in families with incomes at or below the FPL
  • Certain Medicare beneficiaries
  • People who lost their Medicaid coverage at the end of the COVID Public Health Emergency but still qualify under income guidelines

How to Find Out if You are Eligible for Coverage

Even if you were told you didn’t qualify in the past, you may qualify under new rules. You can see if you qualify in two ways:

  1. Visit your state’s Medicaid website. You can apply right now and find out if you qualify. If you qualify, coverage can begin immediately.
  2. Fill out an application in the Health Insurance Marketplace. If it looks like you or anyone in your family is eligible for Medicaid and/or CHIP, the state agency will be notified so you can enroll.

Figuring out if you are eligible and how to apply can be confusing. At Freeway Insurance, we are happy to help you find the right coverage for you and your family – at no charge.

What is the Difference Between ACA, Medicare and Medicaid?

Traditional Medicare is health coverage provided by the government. The ACA is a health policy that you buy from an insurance company, or get from your employer. Medicaid is a government healthcare subsidy that offers free or low-cost care for those who qualify based on income and family size. There are many different types of health insurance that fall outside the realm of Medicaid.

Who Pays for Health Services Provided by Medicaid?

The federal government and the states pay for these health services. States make payments to healthcare providers based on a fee-for-service agreement or through prepayment arrangements such as health maintenance organizations (HMOs).

Each state is then reimbursed for a share of their expenditures from the federal government.

States may require small deductibles, coinsurance, or copayments on some beneficiaries for certain services. However, the following Medicaid beneficiaries must be excluded from cost sharing:

  • Pregnant women,
  • Children under age 18, and
  • Hospital or nursing home patients who are expected to contribute most of their income to institutional care.

Find Affordable Health Insurance Today

Freeway Insurance agents are bilingual and experienced in helping people find their way through the health coverage maze – even Medicaid. Freeway has partnered with many insurance carriers to help customers find affordable health plans at low or no cost. And, as always, Freeway’s services and your healthcare quotes are 100% free! Give us a call today at 800-777-5620 or visit us at one of our many convenient locations.

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