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Navigating medical insurance can be a real minefield. Add that to the daily struggles of dealing with a chronic illness, and you have a recipe for stress and disaster.
You may have heard of Medicaid, and you’ve likely heard of Medicare too. This isn’t two different terms for the same organization – but that’s not true. In fact, you may only be able to qualify for one of the providers. However, if you’re eligible for both Medicaid and Medicare, you can use both together to get the highest quality of medical care available.
What is Medicaid, and is it suitable for low-income families? Can medicaid really help? What kind of services and medical treatments – like dialysis – are covered by Medicaid?
Let’s find out.
Medicaid is an organization that offers health care and other related services to eligible adults and children. Medicaid is primarily aimed at low-income individuals and families.
Services covered by Medicaid can vary from state to state. To apply for medicaid, you may need to be below an income limit, and the plan you take on may depend on what you’re eligible for and the rules in your state.
However, certain services (like emergency services) are mandatory in all states:
Interestingly, Medicaid also offers long-term care, which Medicare (which we’ll discuss later) does not.
Children are also eligible for even more mandatory Medicaid services besides pediatric care:
For a full list of what Medicaid is legally obliged to cover, check out their website.
Medicaid can be used as supplemental insurance to Medicare. If possible, it’s best to use both of these services at once.
This is because Medicare covers acute care services – focusing on the actual dialysis part of your treatment, as well as other medical care you might need. Medicaid covers services that aren’t covered by Medicare. This includes long-term care, a nursing home, home health care, transportation, and more.
Surprisingly, using both of these services can be the best way to approach dialysis treatments. While Medicare is considered the primary health insurer, Medicaid can pick up the slack, dealing with treatments Medicare doesn’t cover, and stepping in if your Medicaid is exhausted.
However, not everyone is eligible for Medicare. If that’s the case, you’ll need to rely on Medicaid as your primary insurer.
Medicaid covers medically essential procedures, and that includes dialysis. However, you may need to check out what forms of dialysis are covered by Medicaid in your state. For example, while the traditional in- and out-patient dialysis are covered by most health insurance providers, you may not have as many options as regards home dialysis and nocturnal dialysis.
If you plan to have home dialysis, you may need training. Not all insurance providers cover that training, or you may have to make a copayment.
Medicaid is mandated to cover certain vital health services, such as:
While some services may vary from state to state, these are the basics you should expect from a Medicaid healthcare plan.
Other services, like dental care, physical therapy, prescription drug coverage, prosthetic devices, and more may be covered by Medicaid. To find out more, check your Medicaid plan or speak to a representative.
Notably, Medicaid offers long-term care, which Medicare does not. This makes Medicaid a good choice for any kind of long-term care, which can include dialysis. Dialysis is a treatment, not a cure. Unless you’re able to get a kidney transplant or some other permanent treatment, you’ll need dialysis to stay alive.
What Medicaid doesn’t cover can depend on where you live. While rules are often different for children (children may qualify for mandatory services which aren’t available for adults), Medicaid may not cover these treatments for adults:
Other services which might require a copayment (a small payment from you as well as your insurance provider) include:
It’s always best to check what your copayment will be. Services like Medicare work on an 80-20 division of the final bill – they pay 80%, and you pay 20%.
Medicaid and Medicare are very similar organizations. Both were set up in 1965, and they both have the aim of providing affordable health care to chronically ill and/or low-income Americans.
There are some key differences. Medicare is viewed as the “primary” insurer, and often covers the main load of medical care.
Medicaid works to fill in the gaps that Medicare leaves, such as long-term nursing care, transportation, and more.
The best way of approaching medical care is to use both Medicare and Medicaid, to provide thorough medical coverage and a safety net. Healthcare is a serious business, especially if you’re grappling with a long-term, chronic condition like renal failure. It’s wise to take as many precautions as you can.
Figuring out health insurance can be tough. Using Medicaid and Medicare benefits at the same time can be complicated, but it’s worth it.
While Medicare is often the go-to health insurance for eligible patients, Medicaid is more inclusive and can fill in the gaps left by Medicare.
