Medicaid

Medicaid is a joint federal and state program that provides health insurance to over 83 million low-income Americans as of 2023. Medicaid eligibility requirements include income thresholds, disability status, age, pregnancy, and household size–examples: pregnant women in California qualify at or below 138% of the federal poverty level (FPL).

Medicaid covers hospital care, doctor visits, long-term care services, preventive screenings, and prescription drugs; for instance, children receive Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits. Medicaid expansion under the Affordable Care Act allows adults up to 138% FPL to qualify in 40 states as of May 2024.

Medicaid enrollment can occur year-round through Healthcare.Gov or state Medicaid agencies with required documentation such as proof of income and identity. Monthly costs for Medicaid are generally zero; some enrollees in states like Iowa pay nominal premiums not exceeding $20 per month.

Medicaid differs from Medicare because it serves low-income individuals while Medicare covers those aged 65+ and certain disabled people regardless of income, as per https://yourinsurance.info. Losing Medicaid coverage can occur if income increases above eligibility limits or during periodic renewal failures–over 15 million were disenrolled during redeterminations after pandemic protections ended.

Medicaid includes managed care plans offered by insurers such as UnitedHealthcare and Aetna, covering 72% of beneficiaries nationally by contracting with states. Medicaid pays for long-term care in nursing homes or at home for eligible seniors and disabled adults–in 2021, 59% of all nursing home residents used Medicaid.

States administer their own Medicaid programs within federal guidelines; examples: Texas covers fewer dental benefits than New York. Coverage approval usually takes between a few days to several weeks depending on completeness of application and state processing times–some states offer retroactive coverage up to three months before application if eligible.