What is Medicaid?

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, older adults, and people with disabilities. Medicaid is administered by the states, in accordance with federal requirements. The program is jointly funded by the states and the federal government.

What are savings programs for?

State Medicare Savings Programs (MSP) programs help pay premiums, deductibles, coinsurance, copayments, prescription drug coverage costs.

What are the benefits that medicaid provides?

States establish and administer their own Medicaid programs and determine the type, amount, duration, and scope of services within broad federal guidelines. Federal law requires states to provide certain mandatory benefits and allows states the option of covering other optional benefits.

Mandatory benefits include services including inpatient and outpatient hospital services, medical services, laboratory and X-ray services, and home health services, among others. Optional benefits include services including prescription drugs, case management, physical therapy, and occupational therapy.

Prescription drugs

Medicaid is a joint federal-state program that pays for health assistance for individuals and families with low incomes and relatively few assets. While pharmacy coverage is an optional benefit under federal Medicaid law, all states currently provide outpatient prescription drug coverage to all categorically eligible individuals and most other enrollees within their state Medicaid programs.

Medicaid prescription drug programs include the management, development, and administration of systems and data collection necessary to operate the Medicaid drug reimbursement program, the calculation of the federal upper limit for generic drugs, and the drug review program. use of medications.

What are the costs of Medicaid?

States have the option of charging premiums and setting out-of-pocket (cost-sharing) requirements for Medicaid enrollees. Out-of-pocket costs can include copays, coinsurance, deductibles, and other similar charges. Maximum out-of-pocket costs are limited, but states may impose higher fees for specific groups of people with somewhat higher incomes. Certain vulnerable groups, such as children and pregnant women, are exempt from most out-of-pocket costs and copayments and coinsurance cannot be charged for certain services.

Managed care

Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services.

By contracting with various types of MCOs to deliver Medicaid program health care services to their beneficiaries, states can reduce Medicaid program costs and better manage utilization of health services. Improvement in health plan performance, health care quality, and outcomes are key objectives of Medicaid managed care.

What is PACE?

PACE (Program of All-inclusive Care for the Elderly) is a Medicare/Medicaid program that helps people meet health care needs in the community.

Lower prescription costs

Qualify for extra help from Medicare to pay the costs of Medicare prescription drug coverage (Part D). You’ll need to meet certain income and resource limits.

Find your level of Extra Help (Part D)

Information for how to find your level of Extra Help for Medicare prescription drug coverage (Part D).

Supplemental Security Income (SSI)

A monthly benefit paid by Social Security. SSI is for people with limited income and resources who are disabled, blind, or age 65 or older. SSI benefits aren’t the same as Social Security retirement or disability benefits.

× How can we help you?