What Does Medicaid NOT Cover? [Get The Facts]

Have you ever wondered what might be covered by your Medicaid insurance, and on that matter what are the services that are not covered?

If you often get confused by the Medicaid rules and regulations, don’t worry you are not the only one. New beneficiaries have a problem understanding all the details and fine print, so we are here today to discover all the information you need.

Keep on reading to find out what is Medicaid and what is not covered. In addition, you will learn everything about this amazing financial support and how to use the benefits to your advantage.

So, without further ado, let’s jump right in.

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What Is Medicaid?

Medicaid is a governmental assistance program in the United States that provides families and individuals in need with medical assistance. Unlike many other financial support programs in the country, this one is focused only on the medical aspect and covers the expenses of medically necessary services.

Some of those benefits provided are mandatory so each state has to allow them for every Medicaid beneficiary, but most of them are optional and the states have the right to choose whether or not to enforce them.

This complicates things as each state has its own set of rules and regulations, so people on the Medicaid programs are often not aware of what is and is not covered.

One of the main things to remember is:

  • Anything medically necessary is covered;
  • Children, young people under the age of 21, and the elderly have special support;
  • Medicaid is for everyone who is under the poverty line.

So, it doesn’t matter how old you are or do you have any disabilities, the program will help you cover the costs of medical services needed.

What Does Medicaid Not Cover?

Medicaid is an amazing program that helps millions of people who are living on a low income, but even this program has restrictions. 

Coverage for different things depends on the state you live in, so there are no universal rules. But, most of the time Medicaid will not cover:

  • Private nursing or caregiving services provided by a household member;
  • Disposables like bandages, adult diapers, and others;
  • Cosmetic surgery;
  • Elective procedures;

Some of the optional benefits can be covered by Medicaid in your state, but there are a few that are rarely covered in states like:

  • Physical and occupational therapy
  • Dental and eye care for adults
  • Chiropractic care
  • Hospice
  • Prosthetics 
  • Respiratory care
  • Podiatry services
  • Speech, hearing, and language disorder services 

As you can see there are a lot of thighs that can be covered but states decide not to. But, what is covered? Keep on reading to find out more.

What does Medicaid cover?

Now that we are familiar with some of the procedures that are not covered we can make a shortlist of things that Medicaid will cover in most states.

Here is what you can expect to be covered:

  • Hospital services, both inpatient and outpatient
  • Services provided by physicians
  • Services for laboratories and x-rays
  • Home health care services
  • Screening, Diagnosis, and Treatment at an Early and Regular Stage (EPSDT)
  • Services for Nursing Homes
  • Care in a rural health clinic
  • Services provided by federally authorized health centers
  • Services for family planning
  • Services provided by nurse-midwives
  • Services provided by a Certified Pediatric and Family Nurse Practitioner
  • Services provided by a stand-alone Birth Center (when licensed or otherwise recognized by the state)
  • Transportation to medical appointments
  • Pregnant women’s tobacco cessation counseling

As we mentioned before children are under special treatment in Medicaid and they are covered for:

  • Dental treatment
  • Physiotherapy
  • Eyeglasses and eye care
  • Hearing aids and hearing care
  • Services for Podiatry
  • Devices for prosthetics
  • Mental health treatment
  • Palliative care
  • Some assisted living facilities

This is an amazing opportunity to prevent illness and cut the costs of medical care in the future.

Does Medicaid cover all the costs?

In most cases, Medicaid will cover all the costs and medical bills, so there is no need for co-payment. 

Keep in mind that some states have regulations that allow people who have higher incomes to be a part of the Medicaid program and in those cases, there might be small monthly premiums, deductibles, or copayments required. 

How to know what is covered by Medicaid?

All of the regulations can leave people unsure about the coverage. Even if you know what is or is not covered in general, it can be different in your state. So, how to know what are your benefits?

You should always ask your local Medicaid representatives for more information. The staff will be able to help you with coverage, eligibility, cards, and various doctors that are available. But, most of all they will have all the information you need about your benefits and how to use them.

In addition, you can always contact your health insurance company. The number is usually on the back of your health insurance card and the staff there should also be able to help.

What Are The Disadvantages Of Medicaid?

Even though there are hundreds of reasons why Medicaid is one of the best things for families in need there are a few disadvantages you need to know about.

Here are a few disadvantages:

  • Rules and regulations are different in each state which can be quite confusing and frustrating;
  • Medicaid budget changes every year and so does the medical services that are covered;
  • The quality of provided care can be lower.

But, with so many people who are getting the right care at the right time these disadvantages are often overlooked.

Final Thoughts

Medicaid is an effective and complex system that provides financial assistance to families in need. It’s focused on medical services, but with the limitations, we mentioned above.

Now that you are familiar with all of the covered and non-covered benefits, it will be easier to navigate through the program. For all updates make sure you visit our page.

David Duford
Author: David Duford