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What Does Medicaid Cover

The Medicaid Program: Find Out What It Can Do For You

So, you're wondering about the Medicaid program and whether you qualify for benefits. Maybe your income is a bit low this year and life would be a lot easier if you just had some assistance with medical expenses. Many part-time working mothers can qualify for the program based on their income. It's a great help for medical and dental services for children, which can save you a bundle each year.

What Do You Get With Medicaid?

Medicaid has mandatory federal programs for the United States. In addition to those benefits, each state decides on the optional benefits they provide. The mandatory benefits for all include inpatient and outpatient hospital stays, early and periodic screenings, diagnostic and treatment services and nursing facility services. In addition, it covers home health, physician and rural health clinic services, laboratory services, X-rays, family planning, nursing services, midwives, pediatric services and birth centers. You can also get transportation to medical appointments and tobacco cessation counseling if you're pregnant. Having health coverage for all of these services can be a tremendous help financially.

Examples of other types of coverage by state include:

  • Texas Medicaid: covers dental and vision
  • Florida Medicaid: covers dental and podiatry
  • Ohio Medicaid: covers dental, vision, alcohol and drug addiction
  • New York Medicaid: may have a small co-pay for services
  • California Medicaid: covers breast and cervical cancer treatment
  • North Carolina Medicaid: covers early intervention for special needs infants and toddlers

Check with your local office for information on your state's Medicaid coverage.

What Does Medicaid Cover at the Dentist?

Dental Implants & Medicaid

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Dental coverage is provided for your kids under a program called Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits. It covers routine dental exams, cleanings and X-rays. If your kids play sports, they may eventually need emergency dental care for a tooth that gets chipped or cracked. This is also covered at no cost. Any type of pain or infection in the mouth is covered as well as tooth restoration.

Adult dental services may or may not be covered by your state's Medicaid program. Most provide emergency dental services to adults, but less than half of the states provide the same comprehensive dental care that your children would receive.

Braces for children can break your bank and sometimes simply be out of the question. The good news is that Medicaid can pay for them, helping to provide enough orthodontic care to further oral health, prevent disease and see to the restoration of a child's oral structures. So, if the dentist deems braces necessary for your child under this type of evaluation, Medicaid will cover the cost so they can have straight pearly whites in their selfies.

Does Medicaid Cover Glasses?

The vision section of Medicaid is also under the EPSDT program for kids under 21. It includes all the basic important items for your children, including eye exams and complete pairs of glasses. Each state decides how often you can get these services.

Some states offer the same type of vision care for adults. They may also include glaucoma testing and pay a portion for cataract surgery, because it is classified as a medical condition. The state may also cover a pair of glasses after your surgery if you need them.

What Does Medicaid Cover that Medicare Doesn’t?

Health Insurance for Newborn Babies

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Medicaid for adults covers some items that Medicare doesn’t. You’ll get health insurance coverage for doctor visits, nursing home care, home health care and hospital expenses. You'll also get long-term care whether in a nursing home or at home. Medicaid doesn’t cover prescription drugs for adults, but if you’re eligible by income, it can pay your Medicare Part D premium each month for your prescription coverage.

The best thing to do is check the Medicaid eligibility guidelines for your specific state. Having help from the Medicaid program when your children are sick or hurt can not only make a difference in their young lives but bring some welcome peace of mind to a working parent.