Medicaid coverage for seniors depends on which state you live in and your income level

Medicaid is a joint federal and state program, which means each state sets its own rules about what it covers for people over 65. Some states cover dental work, vision care, and hearing aids; others do not. Some states cover nursing home care automatically; others require you to spend down your savings first. The only way to know what your state covers is to contact your state Medicaid office directly or speak with a caseworker who handles seniors in your area.

Medicare is the federal program for people 65 and older. Medicaid is for people with low income and limited assets. Many seniors have both — this combination is sometimes called "dual may be able to access." If you have both programs, Medicare pays first for most services, and Medicaid fills in gaps that Medicare does not cover.

Key Takeaways

  • Every state covers hospital stays, doctor visits, and prescription drugs through Medicaid, but coverage details and cost-sharing rules vary by state.
  • Long-term care in nursing homes and assisted living facilities is covered by Medicaid in all states, but income and asset limits differ.
  • Dental, vision, hearing aids, and mental health services are optional benefits that some states cover and others do not.
  • Your state Medicaid office is the only source that can tell you exactly what is covered under your state's plan and what you will pay out of pocket.

Services all states must cover for seniors

Federal law requires every state Medicaid program to cover certain services for seniors. These include inpatient hospital care, outpatient hospital services, physician services, and laboratory and X-ray services. All states also cover prescription drugs, though the list of covered medications and your out-of-pocket cost varies. Home health services are covered in all states if a doctor orders them and you are homebound.

Mental health and substance use treatment are covered in all states, including both inpatient psychiatric hospital care and outpatient mental health services. However, the number of visits you can have per year, whether you need a referral, and which providers are in-network differ by state. Nursing facility care is a required benefit, meaning all states cover it, but the daily rate the state pays and whether you must meet an asset test first varies.

Long-term care coverage: nursing homes and assisted living

Medicaid is the largest payer of nursing home care in the United States. If you need a nursing home and your income and assets fall below your state's limits, Medicaid will pay the facility directly. The income and asset limits vary widely — some states allow you to keep $2,000 in savings; others allow more. Some states count your home as an asset that disqualifies you; others protect it. You must check your specific state's rules.

Assisted living facilities are treated differently than nursing homes. Some states cover assisted living as a Medicaid benefit; others do not. If your state does cover it, the daily rate is usually lower than what the state pays for nursing home care, and you may have to pay the difference out of pocket. A few states offer home and community-based services waivers that let you receive care at home instead of in a facility, but these programs often have waiting lists.

Optional benefits: dental, vision, hearing, and transportation

States can choose whether to cover dental services, eyeglasses, hearing aids, and non-emergency medical transportation. About half the states cover some dental work; the other half cover little or none. Vision coverage is similarly split — some states cover eye exams and glasses; others cover only eye exams for disease. Hearing aids are covered in fewer than half the states.

Non-emergency medical transportation — rides to doctor appointments for people who cannot drive — is covered in most states, but the program may require you to use a specific provider or call ahead to schedule. If your state does not cover a service you need, you may be able to find it through a community health center, senior center, or local nonprofit that offers reduced-cost care based on income.

What you pay out of pocket under Medicaid

Medicaid typically charges lower out-of-pocket costs than Medicare or private insurance. Most states charge no copay for doctor visits, though some charge $1 to $3. Hospital stays usually have no copay. Prescription drugs may have a copay of $1 to $5 per medication, depending on the drug tier. Some states charge nothing for prescriptions.

For nursing home care, Medicaid usually requires you to pay a portion of your monthly income toward the cost — typically all but $30 to $50 per month, which you keep for personal needs. The exact amount varies by state. If you have a spouse still living at home, Medicaid protects a portion of your joint assets so your spouse is not left without money.

How Medicaid for seniors differs from Medicare

Medicare is based on age and work history, not income. Medicaid is based on income and assets. If you are 65 or older and your income is below your state's limit, you may be on Medicaid, Medicare, or both. If you have both, you are "dual may be able to access," and Medicare is the primary payer — it pays first, and Medicaid pays second for services both programs cover.

Medicare has a yearly deductible and copays that increase with use. Medicaid typically has no deductible and lower copays. However, Medicare covers some services Medicaid does not — such as certain preventive screenings — and Medicaid covers some services Medicare does not, such as long-term nursing home care without a time limit. Understanding which program covers what is essential if you have both.

How to find out what your state covers

Contact your state Medicaid office directly. You can find the phone number by searching "[your state] Medicaid" online or by calling 211, a free referral service. Have your income and asset information ready, because coverage rules depend on whether you meet your state's financial limits. A caseworker can tell you what services are covered, what you will pay, and whether you need a referral to see a specialist.

If you are already receiving Medicaid, your state sends you a handbook or summary of benefits each year. This document lists covered services, copays, and how to find in-network providers. If you cannot find yours, call the number on your Medicaid card. If you do not have a card yet, contact your state office to start the process.

Frequently Asked Questions

Does Medicaid cover prescription drugs for seniors?

Yes, all states cover prescription drugs through Medicaid. The list of covered medications and your copay amount vary by state. Some states have no copay for prescriptions; others charge $1 to $5 per medication depending on the drug type. Ask your state Medicaid office for a copy of the formulary — the official list of covered drugs.

Will Medicaid pay for my nursing home if I have some savings?

It depends on your state's asset limit. Most states allow you to keep $2,000 in savings and still be on Medicaid; a few allow more. Your home is usually protected and does not count against the limit. If you have more than the limit, you may need to spend down your savings on care costs before Medicaid begins paying. Contact your state Medicaid office to learn your state's exact rules.

What if my state does not cover a service I need, like dental work?

Look for a federally may have access to health center (FQHC) in your area — these centers offer dental, vision, and other services on a sliding fee scale based on income. You can find one by searching "FQHC near me" or by calling 211. Some states also run special programs for seniors that cover services Medicaid does not, so ask your state office what else may be available.

Can I have both Medicare and Medicaid at the same time?

Yes. If you are 65 or older and your income is below your state's Medicaid limit, you may be on both programs. Medicare pays first for most services, and Medicaid covers costs Medicare does not pay. This is called "dual may be able to access" status. Your state Medicaid office can tell you whether you meet the income and asset limits for your state.

How do I know if I am on Medicaid or just Medicare?

Medicare sends you a red, white, and blue card. Medicaid sends you a card specific to your state — the color and design vary. If you have both, you will have two cards. If you are unsure, call the number on whichever card you have, or contact your state Medicaid office and give them your Social Security number.