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Do You Need Health Insurance If on Medicaid?

Medicaid is a publicly funded health insurance plan for low-income people. Each state uses federal poverty guidelines to determine which families are eligible for Medicaid. If a family is on Medicaid, it is expected to use Medicaid insurance to pay for most health care needs; however, in some cases families may be allowed to supplement Medicaid with private insurance.

  1. Private Health Insurance

    • If a person has very low income, he may qualify for subsidized private health insurance in addition to Medicaid. In some cases, Medicaid may also pay for the premiums for private insurance if a person is of sufficiently low income. If a family qualifies for Medicaid, the parents may need to purchase private insurance for their children if Medicaid does not cover all needed services.

    Managed Care Programs

    • Most Medicaid services are provided through managed care programs. Managed care programs are health services provided by your state of residence; in most cases, you must use doctors who have contracted with the managed care program to receive coverage for services. If your managed care program does not cover a service you require, you may need to pay for it out of pocket or use private insurance.

    Covered Services

    • Medicaid covers most preventive health services, such as doctor visits, prescriptions and lab work. It does not cover experimental treatments and may not cover psychological services such as group or individual therapy. Some Medicaid providers offer prenatal care services for pregnant women. Medicaid may limit your benefits if its representatives believe you are abusing the system or otherwise do not think you need as many services as you are trying to have covered.

    Considerations

    • If your income falls below the poverty guidelines and you just need basic health services, Medicaid is probably sufficient for your needs. Only some forms of private insurance are allowed in addition to Medicaid, so it may not be worth your while to get private insurance if you are applying for Medicaid. However, if you have special health needs that are unlikely to be addressed by Medicaid, you may want to investigate supplementing it with private insurance.

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