Medicaid Basics To Know

Medicaid is a joint state/federal health insurance program that is administered by the state. It provides health coverage for low-income individuals who meet income restrictions or have qualifying medical needs; especially pregnant women, children and the disabled. Well over 70 million people nationwide are enrolled in this program, making it the single largest source of health insurance in the nation.

An Overview of Medicaid

In Nevada, over 850,000 people are enrolled in Medicaid or Nevada Check Up, which provides free or near free coverage for qualifying individuals under 18.

While it provides robust stand-alone coverage, Medicaid can also be used alongside other health insurance coverages such as private health insurance, Medicare, and Veterans’ Administration benefits. When used alongside other health insurance plans, it covers out-of-pocket costs not paid for by the primary health insurance, reducing your out-of-pocket expenses.​

What Does Medicaid Cover?

Medicaid provides comprehensive coverage for a broad range of health services, which can help you get the care you need while avoiding burdensome medical debt. While this health insurance plan features robust coverage, it may not pay for all the services you need for general health.

Medicaid benefits include inpatient and outpatient hospital services, home health care, lab and x-ray services and routine care. Nevada’s Medicaid program may also cover case management, prescription drugs, physical therapy, and occupational therapy.

Medicaid’s scope of coverage is comparable to private health insurance plans that comply with the Affordable Care Act. Some covered services include:

• Preventative and diagnostic care
• Family planning services
• Durable and disposable medical supplies and equipment
• Vision, hearing and dental services
• Maternity care
• Specialty care
• Prescription drugs
• Physical, occupational and speech therapy
• Smoking cessation products
• Hospital care
• Immunizations
• Lab and radiology services

Does Medicaid Cover Vision and Dental Services?

Because Medicaid is administered by the states, eligibility requirements and scopes of coverage vary. In some states, only children have coverage for vision and dental, while other states expand this coverage to everyone enrolled in the program.

In some cases, only emergency care is covered, meaning that you must pay for routine and preventative care on your own. Additionally, policies may vary from one year to the next. Even if you have been enrolled in Medicaid for years, it is always a good idea to confirm your benefits, so you know what to expect when you receive vision or dental services.

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Medicaid in Nevada

Nevada Medicaid covers dental services, including preventative care such as routine cleanings and treatment services such as tooth extractions or cavity repair, for those aged 21 and under. For those over 21, the program only covers emergency exams and tooth extractions. If your circumstances meet certain requirements, you may be eligible to have full or partial dentures paid for by Medicaid.

Nevada Medicaid pays for medically necessary vision services, including care for eye disease, routine eye exams and prescription glasses. You get a certain allowance towards frames. If you want frames that cost more than the allowance, you must pay the difference out of pocket. Contacts are only covered when they are medically necessary.​

Qualifying for Medicaid

In all states, certain groups are eligible for this coverage, including income-qualifying families, pregnant women, children, and Supplemental Security Income beneficiaries. Some states may extend coverage to people who meet other requirements, such as children in foster care or those who receive home and community based services.

In 2014, Nevada did expand Medicaid with the passage of the ACA.

There are several ways that the state’s Department of Health and Human Services Division of Welfare and Supportive Services screens for Medicaid eligibility.

Family Medical Coverage

Screens individuals, families, and specialized households with limited incomes

Nevada Check Up

Is available to children in income-qualifying households who are not covered by Medicaid or private health insurance

Medical Assistance to Aged, Blind and Disabled

Is used to screen those who qualify for Supplemental Security Income, live in residential care facilities or nursing homes or are eligible for Home and Community-Based waiver programs

Qualified Medicare Beneficiaries

Is for individuals dually eligible for Medicare and Medicaid

Hospital Presumptive Eligibility

Enables hospitals to determine whether certain individuals qualify for Medicaid based on preliminary information

Nevada Medicaid Eligibility Requirements

To be eligible for Nevada Medicaid, you must be a permanent resident of the state and a U.S. citizen or legal resident. In all states, you can qualify for Medicaid based on your household size, income, family status, age or disability. Nevada is among the states with an expanded Medicaid program, meaning that you can qualify for the program based on your income alone.

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