What Medicaid Covers for Seniors

Medicaid covers hospital stays, doctor visits, prescription drugs, and long-term care services for seniors who meet income and asset limits. The specific services vary by state — some states cover dental care and hearing aids, others do not. Most seniors on Medicaid also have Medicare, and Medicaid typically pays the Medicare premiums and cost-sharing that Medicare does not cover. The best way to know what your state covers is to contact your state Medicaid office or call 1-800-MEDICARE to speak with someone who can look up your specific situation.

Medicaid is a joint federal and state program, which is why coverage differs. A senior in New York may have access to services a senior in Texas does not. This guide covers the core services most states cover, the gaps that remain, and how to find out what your state includes.

Key Takeaways

  • Medicaid covers inpatient hospital care, emergency room visits, doctor appointments, lab work, and X-rays in all states, but covers prescription drugs only if your state chooses to include that benefit.
  • Long-term care in a nursing home or assisted living is covered by Medicaid in most states, but you must spend down your assets to the state limit (usually $2,000 or less) before Medicaid pays.
  • Medicaid covers some services Medicare does not, such as dental care, vision care, and hearing aids in certain states, but not all states offer these benefits.
  • If you have both Medicare and Medicaid, Medicaid pays your Medicare premiums and covers the deductibles and copayments that Medicare requires you to pay.
  • Your state Medicaid office is the only source that can tell you exactly what services are covered where you live, because each state designs its own Medicaid program.

Hospital and Doctor Care That Medicaid Covers

Medicaid covers inpatient hospital stays in all states — this includes room, meals, nursing care, and basic tests during your stay. It also covers emergency room visits, even if you do not end up being admitted to the hospital. Medicaid pays for doctor office visits, including routine checkups and visits for illness or injury.

Laboratory work and imaging (X-rays, CT scans, ultrasounds) are covered when ordered by your doctor. Medicaid also covers preventive care such as cancer screenings, blood pressure checks, and vaccinations. Mental health visits and substance abuse treatment are covered in all states, though the number of visits or the types of providers may be limited.

What Medicaid does not cover: cosmetic surgery, most dental work (though some states cover emergency dental care), and routine eye exams or glasses (though some states do cover these). If your doctor orders a service and you are unsure whether Medicaid covers it, ask your doctor's office to check with your state Medicaid program before the service is provided.

Prescription Drugs and Pharmacy Coverage

Prescription drug coverage under Medicaid varies significantly by state. Some states cover a broad range of medications with few restrictions. Other states limit the number of prescriptions you can fill per month, require you to try a cheaper drug first before covering a more expensive one, or exclude certain drug categories entirely.

If you are 65 or older and have Medicare, you also have access to Medicare Part D (prescription drug coverage), which is separate from Medicaid. If you have both programs, Medicare Part D is your primary coverage for drugs, and Medicaid covers the cost-sharing (copayments and deductibles) that Part D requires. Your state Medicaid office can tell you which drugs are covered under your state's plan and whether there are restrictions on how many you can fill each month.

Some medications require prior authorization, meaning your doctor must contact Medicaid and get approval before the pharmacy will fill the prescription. This can delay your medication by a few days, so if you need a refill urgently, tell your doctor's office to request expedited review.

Long-Term Care: Nursing Homes and Assisted Living

Medicaid is the largest payer of nursing home care in the United States. It covers the full cost of a nursing home stay if you meet the medical need (your doctor must certify that you require skilled nursing care) and the financial need (your assets and income fall below your state's limits). Most states set the asset limit at $2,000 or less for a single person, though some states allow slightly more.

Medicaid covers room and board, nursing care, therapy, medications, and meals in a nursing home. It does not cover a private room unless medically necessary — Medicaid typically pays for a semi-private room. Some states also cover assisted living facilities, but coverage is less common and the rules vary widely. Contact your state Medicaid office to ask whether assisted living is covered in your state and what the rules are.

Before Medicaid pays for a nursing home, you must spend down your savings to the state limit. This is called "spending down to Medicaid." Your home and one vehicle are usually protected and do not count toward the limit. A spouse who is still living at home may be allowed to keep more assets. A Medicaid planner or elder law attorney can explain the rules for your state and help you understand what assets you must spend and what you can protect.

Services Medicaid Covers That Medicare Does Not

Medicaid covers some services that Medicare excludes or limits. These include personal care information (help with bathing, dressing, and toileting at home), adult day care, and transportation to medical appointments. Medicaid also covers some dental services in certain states — emergency dental care is more commonly covered than routine cleanings or fillings.

Vision care and hearing aids are covered by Medicaid in some states but not others. If you need glasses, a hearing aid, or dental work, ask your state Medicaid office whether these services are covered. If they are not covered by Medicaid, you may be able to find low-cost options through community health centers or nonprofit organizations in your area.

Home and community-based services (HCBS) are a growing area of Medicaid coverage. These include in-home care, adult day programs, and residential support for seniors who want to remain in their homes rather than move to a nursing facility. Not all states offer HCBS waivers, and those that do often have waiting lists. Your state Medicaid office can tell you whether these services are available and how to get on a waiting list if there is one.

What Medicaid Does Not Cover

Medicaid does not cover cosmetic procedures, most dental care (in most states), routine eye exams and glasses (in most states), hearing aids (in most states), and over-the-counter medications. It also does not cover private-duty nursing care at home in most states, though some states cover this under HCBS waivers.

Medicaid does not cover care in assisted living facilities in most states, though a few states have begun to cover this service. It does not cover custodial care (help with daily living activities) in a nursing home if you do not need skilled nursing care — if you only need help with bathing and dressing, Medicaid will not pay.

If a service is not covered by Medicaid, you may be responsible for the full cost. Some services may be covered by Medicare instead, or by a supplemental insurance plan. If you are unsure whether a service is covered, ask your doctor or your state Medicaid office before you receive the service.

How Medicaid Works With Medicare for Seniors

Most seniors on Medicaid also have Medicare. When you have both programs, Medicare is your primary insurance and Medicaid is secondary. This means Medicare pays first, and Medicaid covers what Medicare does not pay. In practice, Medicaid usually pays your Medicare Part B premium (currently $164.90 per month for most people, though it varies by income), your Medicare deductibles, and your copayments.

If you have both Medicare and Medicaid, you are sometimes called a "dual may be able to access" beneficiary. Dual may be able to access seniors often pay very little out of pocket for medical care because Medicaid covers the cost-sharing that Medicare requires. However, you must stay within the Medicaid income and asset limits to keep your Medicaid coverage — if your income or assets rise above the limit, you may lose Medicaid even though you still have Medicare.

If you are unsure whether you have both Medicare and Medicaid, call 1-800-MEDICARE and ask. They can tell you what coverage you have and what each program covers for your specific situation.

How to Find Out What Your State Covers

The fastest way to learn what Medicaid covers in your state is to call your state Medicaid office directly. You can find the phone number by visiting Medicaid.gov and selecting your state, or by calling 1-800-MEDICARE and asking for your state Medicaid office number. When you call, have your Medicaid number ready if you have one.

You can also visit your state Medicaid website, which usually has a list of covered services. The website may be hard to navigate, so calling is often faster. If you call and cannot reach someone, try calling your local Area Agency on Aging — they often have staff who know the Medicaid rules for your state and can answer questions about coverage.

If you are considering a specific service (such as dental work, a hearing aid, or home care), ask your doctor's office to contact your state Medicaid program and ask whether the service is covered before you schedule it. This prevents surprises and gives you time to plan if the service is not covered.

Frequently Asked Questions

Does Medicaid cover dental work?

Medicaid covers emergency dental care (such as treatment for a severe infection or tooth extraction) in most states. Routine care such as cleanings, fillings, and dentures is covered in some states but not others. Call your state Medicaid office to ask what dental services are covered where you live.

Will I lose my home if I go on Medicaid for nursing home care?

No. Your primary home is protected and does not count toward the asset limit, even if it is worth a significant amount of money. However, after you pass away, Medicaid may place a lien on your home to recover the cost of your care. An elder law attorney can explain the rules for your state and help you understand what happens to your home.

Does Medicaid cover hearing aids?

Hearing aids are covered by Medicaid in some states but not others. A few states cover them only for children or only in certain circumstances. Call your state Medicaid office to ask whether hearing aids are covered and what the process is to obtain them.

If I have Medicare, do I need Medicaid too?

Medicare and Medicaid are separate programs. You can have Medicare without Medicaid, or both. If your income is low, you may be able to get Medicaid to help pay your Medicare premiums and cost-sharing. Contact your state Medicaid office or call 1-800-MEDICARE to ask whether you may be may be able to access for Medicaid based on your income.

What happens if I move to a different state?

Medicaid coverage does not automatically transfer between states. You must explore for Medicaid in your new state. Coverage may differ — your new state may cover services your old state did not, or vice versa. Contact your new state's Medicaid office within 30 days of moving to learn about coverage and to start the process of transferring your benefits.