What Does Medicaid Cover? | Health Insurance Basics

Health Insurance Basics

What Does Medicaid Cover?

Health insurance can be confusing. The good news is there are choices if you have trouble paying for healthcare. These programs help to cover healthcare costs so you can live a happy and healthy life.

One of these health insurance programs is Medicaid. It is for people who can’t pay for some healthcare costs. Medicaid can help cover costs that aren’t covered by Medicare, which is different. In recent years, the number of people on Medicaid has grown.


There are requirements for Medicaid. You must meet a certain income level. The income levels are $16,000 for an individual or about $32,000 for a family of four.


Medicaid versus Medicare: What’s the difference?
We’ll get to what Medicaid covers. But first, it’s important to understand the goal of the program. Medicaid was started to allow the cost of illness to be shared among sick and healthy people, whether you can pay for it or not.


Many people may be eligible for both Medicaid and Medicare. But there are clear differences between the programs. Medicaid is a state and federal program that provides health coverage if you have a very low income. Medicare is a program that provides health coverage if you are 65 or older or have a severe disability, no matter your level of income.


What does Medicaid cover?
States can choose what is covered by Medicaid in their states. But there are certain services they are required to cover, including:

  • Hospital services
  • Imaging services, lab and X-ray
  • Nursing home care and home health
  • Rural health clinics
  • Family planning
  • Transportation for medical care
  • Healthcare professional services
  • Support to quit smoking


Medicaid also covers many optional services. States may choose to provide these optional Medicaid services:

  • Prescription drugs
  • Physical and occupational therapy
  • Speech, hearing and language services
  • Respiratory care services
  • Other diagnostic, screening and rehab services
  • Specialists
  • Dental coverage
  • Dentures
  • Chiropractic services
  • Nursing
  • Personal care
  • Hospice
  • Mental health


States may offer these services, but you may still have to pay for them. It is important to check which services are covered before your doctor’s visit. Knowing what is covered by Medicaid will help you know what you will need to pay.


To see if you can get Medicaid, visit the Commonwealth of Pennsylvania Application for Social Services (COMPASS): https://www.compass.state.pa.us/compass.web/Public/CMPHome.


To learn more about Medicaid, check out these free services:


For more information about Gateway Health Medicaid plans, visit GatewayHealthPlan.com anytime. You can also call Gateway Health Medicaid Member Services at 1-800-392-1147.

  1. https://www.getold.com/understanding-medicaid-the-basics
  2. https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html

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