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Medicaid: How To Maximize Use

If You Can, Get Medicaid To Pay Health Insurance Premiums.

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As a general rule, private plans pay health care providers more money than Medicaid does, opening doors to more health care providers.


It may sound odd but you can get Medicaid even if you have health insurance.


Whether you apply for SSI and incidentally get Medicaid, or are after Medicaid because you are having trouble paying the health insurance premiums, Medicaid will look at allowing you to keep your private health coverage while Medicaid takes over paying the premiums for you. While the criteria differ from state to state, the basic idea is that Medicaid will look to see whether it is cost effective to pay for your health insurance.


For instance, if your premium is $350 a month, and your medical bills run over $1,000 a month, it is clearly in Medicaid's interest to pay your $350 premium instead of the $1,000 medical bills.


In some situations in some states, Medicaid will assume it is cost effective to pay your health insurance premium rather than make a calculation. For instance, if you have HIV and live in California, Medicaid will automatically approve payment of your health insurance premiums without doing a cost calculation.


Keep your plan's Explanation of Benefits (EOB) that show how much the plan is paying on your behalf. Many premium payment plans will require three to six months of EOBs to show that it is cost effective for Medicaid to pay your premiums.


Ideally, if you have Medicaid you won't have to pay any co-pays or deductibles under your health insurance. However, this isn't the case unless the health care provider has an agreement with Medicaid.


It is worth noting that in some states, rather than provide Medicaid, the state will automatically enroll you in the state high risk pool. See High Risk Pools (


NOTE: In some states, you will be penalized if you have health insurance and let it lapse without applying for the premium payment program. Penalties vary, but states want to you to keep and use private health insurance whenever possible.

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