Q What Medical Services Does Medicaid Cover
A. The Delaware Medicaid program pays for many medical services to keep you healthy and to treat you when you are sick. The major services are:
- Inpatient and Outpatient hospital care
- Lab tests
- Dental care
Covered services for the Delaware Healthy Children Program are listed on the DHCP Benefits page.
Child Health Plan Plus
Child Health Plan Plus is a public health insurance program for children ages 18 and younger and pregnant women who earn too much to qualify for Health First Colorado , but cannot afford private health insurance. Note: Health First Colorado and Child Health Plan Plus are both public health insurance programs for Coloradans who qualify. When you apply for Health First Colorado, you are applying for both Health First Colorado and CHP+. You do not need to turn in more than one application for you or your family.
- Children ages 18 and younger
- Pregnant women
- All who qualify must meet certain income level requirements
- Regular checkups
- Mental health and substance use disorder services
Co-pays and Enrollment Fees:
|Program Information Page|
How Does Medicaid Coordinate With Other Insurance
Medicaid coordinates benefits with other insurers as a secondary payer to all other payers. This means that if an insurer and Medicaid both provide coverage of a given benefit, the other payer is first responsible for making payment and Medicaid is responsible only for any balance covered under Medicaid payment rules.
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What Is The Cost
None. Medicaid law prohibits states from charging deductibles, copayments, or similar charges for services related to pregnancy or conditions that might complicate pregnancy, regardless of the Medicaid enrollment category. HHS presumes pregnancy related services includes all services otherwise covered under the state plan, unless the state has justified classification of a specific service as not pregnancy-related in its state plan. States may, however, impose monthly premiums on pregnant women with incomes above 150% of FPL and charge for non-preferred drugs.
Most states that cover pregnant women in their CHIP program do not have cost-sharing or any other fees associated with participation in the program.
Can Uninsured Women Enroll In Marketplace Coverage Upon Becoming Pregnant
Only if it is within the established open enrollment period or a woman qualifies for a special enrollment period , does not have a plan that meets MEC through Medicaid or an employer, and meets income and immigration criteria. Note that except in the states of New York and Vermont, pregnancy does not trigger an SEP.
Under the ACA, people who do not qualify for Medicaid coverage that meets MEC, and have incomes between 100% and 400% FPL, qualify for advance premium tax credits and cost-sharing reductions , which they can use to reduce the cost of health insurance purchased through a Marketplace. Those with pregnancy-related Medicaid in the three states that do not constitute MEC are eligible for Marketplace subsidies. Certain lawfully-present immigrants with incomes under 100% FPL subject to Medicaids five-year ban in their state are also eligible for APTCs. Undocumented immigrants are not eligible for APTCs, CSRs, or Marketplace insurance.
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How Can I Find Health Plans That Cover My Pregnancy
As mentioned, all Marketplace plans must cover maternity care as an essential health benefit. As a leading licensed insurance broker, eHealth offers a wide selection of individual and family health plans at different price points. We make it easy for you to find affordable care that fits your needs. If youd like to get started, just enter your zip code into our plan finder tool to browse plan options. If you have questions, our licensed insurance agents can help you find customized coverage solutions.
How To Learn More And To Apply
Each states Medicaid program covers different benefits, and has different rules for eligibility. As a result of the ACA, many states calculate income to determine eligibility in a different way than they did before 2014 and some states offer Medicaid to more people now. So, if someone was previously determined ineligible for Medicaid, he or she should consider reapplying.
The Health Insurance Marketplace in each state offers a single application to determine whether a person is eligible for Medicaid or eligible for help purchasing private health insurance through the Marketplace. For more information on the Health Insurance Marketplaces, visit www.healthcare.gov or call 1-800-318-2596. See our fact sheet on the Health Insurance Marketplaces at www.diabetes.org/HealthInsuranceMarketplaces.
You can also apply for Medicaid through your states Medicaid office. A link to your states Medicaid office can be found at .
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Person Who Is Aged Blind And/or Disabled
Apply if you are aged , blind, or disabled and have limited income and resources. Apply if you are terminally ill and want to get hospice services. Apply if you are aged, blind, or disabled live in a nursing home and have limited income and resources. Apply if you are aged, blind, or disabled and need nursing home care, but can stay at home with special community care services. Apply if you are eligible for Medicare and have limited income and resources.
Applying For Apple Health Coverage
You have many options to apply for Apple Health coverage. Visit our Apply for or renew coverage webpage to learn more.
When youre ready to apply, youll need:
- Your household monthly income.
- The Social Security numbers and dates of birth for each member of your household.
- Your immigration information, if that applies to you.
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When Can I Enroll In A Health Insurance Plan To Cover My Pregnancy
You can enroll in coverage during the Open Enrollment Period for coverage that starts the following year. Open enrollment usually starts on November 1st of every year.
In most states, being pregnant is not a qualifying event that lets you enroll in or change your health insurance outside of open enrollment. However, there are other life changes that may qualify you for a Special Enrollment Period:
- Birth of a child, placing a child in foster care, or adopting a child
- Getting married
- A divorce or legal separation that results in loss of coverage
- Moving to a new residence
Even thoughpregnancy isnt usually a qualifying event, some states have different laws. Atthe time of publishing, pregnancy qualifies you for special enrollment in NewYork and Maryland. Contact your states health department to learn if pregnancyis a qualifying event where you live.
Requirements For Medicaid Eligibility
You may qualify for Medicaid based on your assets and income, while others will qualify because of their MAGI .
If youre pregnant, between 19 and 64 years old with no children, or a caregiver living with relatives, you may qualify based on MAGI. Some people may qualify for reasons other than their MAGI, including some institutionalized individuals, foster and former foster kids, and others.
Eligibility for Medicaid benefits isnt as simple as it used to be. While your income does play a role, you may qualify or not based on whether you participate in other government programs.
Its a good idea to work with a long-term care expert if you have any questions about what you may qualify for and how to apply for services.
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Student Health Plans: Private Insurance Plans That Are Good For Students
Student health plans represent another way for college students to access health insurance. Some insurance companies offer these plans for students between the ages of 17 and 29, allowing students to pay premiums annually, or semiannually in some instances. Unlike a school-based plan, these plans travel with you wherever you study in the United States.
If you start at one university and then transfer to another university, the coverage transfers with you.
How Do I Apply For Pregnancy Medicaid
To ensure access to care, a government agency can issue a grant at your local county health department, a federally qualified health care center, or some local hospital. You may receive an application in person instead of by mail. For pregnant women under age 19 who meet income requirements for children they may receive Medicaid coverage for them if the parents income is included in the income limits.
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What Services Are Covered
Medicaid covers breast pumps and breast feeding support during your pregnancy and after your baby is born.
You will get health care services through health plans. The health plans all have special programs for high-risk pregnancies. To learn more, go to Health Plan Information. Or call your health plan.
Medicaid Coverage And State
Private health insurance covers the cost of substance-use disorder treatment and services to varying degrees. Each insurer has its own policy, and insured individuals will need to refer to the policy of their respective insurance companies to determine the extent of services that are covered. Many women needing treatment, including pregnant women, may have once had private insurance but have lost that insurance. This section presents information for women who are uninsured, women who may qualify for Medicaid insurance, and women who are currently insured with Medicaid.
Medicaid Services for Women and Children
- Medicaid for Infants and Children
Medicaid for Infants and Children provides medical coverage for children younger than 19 years old. The income limits are determined by the family size and the age of the child or children applying for benefits. There is no limit on resources.
- Medicaid for Families with Dependent Children
Medicaid for Families with Dependent Children provides medical coverage for parent or other caretaker/relative with a child 18 years or younger in the household and for children under age 21. A pregnant woman may also qualify.
The family cannot have more than $3,000 in assets such as savings in the bank.
If the family income is above the cut-off and the child and/or family has high medical bills, the family might still qualify for Medicaid .
- Medicaid for Pregnant Women
Medicaid for Pregnant Women covers only services related to pregnancy:
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How Can I Get Health Insurance While I’m Pregnant
First, see if your employer — or your partnerâs employer — offers health insurance. You will probably get the most coverage at the best price from a health plan offered by an employer. That’s partly because most employers share the cost of insurance premiums with employees.
You can also shop for coverage in the health insurance Marketplace, which is also called an exchange. You may also qualify for Medicaid in your state if your income is low.
In the marketplace, you can:
- Compare health plans side by side
- See if your income is in the range to qualify you for financial help from the government, which will lower the cost of your insurance premiums you may also qualify for lower out-of-pocket costs, such as deductibles, copays, and coinsurance.
You must enroll in a health plan during the open enrollment period, set by either the employer for employer coverage or the federal government for Marketplace coverage. You may qualify for a special open enrollment period if you have a âlife eventâ such as losing other health coverage or moving to a new state. Unfortunately, pregnancy is not one of the life events which qualify you for a special open enrollment period. However, having a baby is. So once you give birth, you can shop for insurance and enroll in a plan even if you missed the open enrollment period. If your income qualifies you for Medicaid, you can enroll at any time during the year.
Is It Ok To Be Pregnant When You Sign Up For A Health Plan
Yes. You can be pregnant when you sign up for health insurance. If this happens, pregnancy is called a pre-existing condition. This means you had the condition before you sign up for health insurance. Under health care law after the ACA,, insurance companies cant deny you coverage or charge you more money to care for pre-existing conditions.
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Can An Uninsured Woman Enroll In A Public Health Insurance Plan Upon Becoming Pregnant
Yes, women who meet the eligibility criteria for Medicaid or Childrens Health Insurance Program can enroll in one of these public programs at any point during pregnancy:
A pregnant woman is eligible for full-scope Medicaid coverage at any point during pregnancy if eligible under state requirements. Eligibility factors include household size, income, residency in the state of application, and immigration status. An uninsured woman who is already pregnant at the time of application is not eligible for enrollment in expansion Medicaid.
If household income exceeds the income limits for full-scope Medicaid coverage, but is at or below the states income cutoff for pregnancy-related Medicaid, a woman is entitled to Medicaid under the coverage category for pregnancy-related services and conditions that might complicate the pregnancy. The income limits for pregnancy-related Medicaid vary, but states cannot drop eligibility for this coverage below a legal floor that ranges from an income of 133% to 185% of FPL , depending on the state. States are permitted to set a higher income cutoff.
Childrens Health Insurance Program
Will A Marketplace Health Plan Also Cover A Newborn
Yes. The ACAs EHB requirement mandates coverage of maternity and newborn care. Newborn care covers childbirth and immediate care for the baby after birth. The specifics of this coverage will vary by state and by each individual plan, but all women in Marketplace coverage must also enroll their baby in coverage soon after birth.
If the newborn is eligible for Marketplace coverage, then the parents can choose to add the baby to the familys existing Marketplace plan or choose a new Marketplace plan for the baby. If they opt for the latter, they can enroll the baby into a new Marketplace plan at any metal tier. However, when enrolling a newborn into Marketplace coverage, other members of the household are generally not permitted to change their existing Marketplace coverage.
What Benefits Does Pregnancy Medicaid Provide
Similar to other health care assistance programs, Medicaid does not pay monetary benefits directly to covered participants. Certain health care providers and health care facilities have a contract with Medicaid to treat those who are covered by Medicaid insurance.
When receiving Medicaid benefits, you should be given a list of medical providers who accept Medicaid or given a website to look for a provider in your area. As long as you receive care from a Medicaid provider, your health care costs will be submitted through Medicaid and will be covered. Pregnant women are covered for all care related to the pregnancy, delivery and any complications that may occur during pregnancy and up to 60 days postpartum.
Additionally, pregnant women also may qualify for care that was received for their pregnancy before they applied and received Medicaid. Some states call this Presumptive Eligibility and it was put in place so that all women would start necessary prenatal care as early in pregnancy as possible.
Talk with your local office to find out if you qualify for presumptive eligibility.
Pregnant women are usually given priority in determining Medicaid eligibility. Most offices try to qualify a pregnant woman within about 2-4 weeks. If you need medical treatment before then, talk with your local office about a temporary card.
Emergency Health Coverage For The Unemployed And Uninsured In Response To The Pandemic And Economic Crisis
To guarantee immediate coverage for all of the unemployed, Congress should pass legislation to rapidly enroll them in Medicaid.
- Topher Spiro
Nearly 38 million Americans have filed claims for unemployment insurance, and many more live in households in which someone has lost a job. As a result, nearly 27 million people could lose their employer coverage and become uninsured. Among this group, about half could be eligible for Medicaid, and several million more would be eligible for subsidies under the Affordable Care Act . However, major gaps in coverage and affordability would remain. If the unemployment rate reaches 20 percent, Oliver Wyman estimates that the number of uninsured will increase by about 9 million people.
To respond to this crisis and help as many people as quickly as possible, this column proposes emergency health coverage for the unemployed and uninsured. This emergency health coverage would build on one of the most popular parts of the ACAits Medicaid expansionby automatically enrolling the unemployed into Medicaid. In doing so, it would guarantee immediate coverage for all of the unemployed.
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Finding Out You’re Pregnant Can Be Exciting And Overwhelming
Your baby is growing and your body is changing, and the more you know about whats happening in your body, the more in control youll feel. Thats why one of the most important things you can do is choose a prenatal care provider who can help you while youre pregnant. A provider who sees you regularly, can spot health problems early and can talk to you about how you can help your unborn baby.
Mothers in prenatal care have healthier pregnanciesmothers who are not in care are three times more likely to have a baby of low birth weight and five times more likely to have a baby who dies at birth.