One government program is by far the largest payer of nursing home costs in the U. S. – Medicaid. Although the funds come from the federal government, the states administer Medicaid. For example, Alabama Medicaid processes applications and distributes benefits for eligible Alabama residents. Although Medicaid covers many medical services, however, there are some services not covered by Medicaid. Before expecting Medicaid to defray your medical costs, it’s important to know what is not covered.
Services Not Covered by Medicaid:
- Routine or annual physical checkups
- Over-the-counter drugs or health supplements
- Custodial care and assistance with activities of daily living (ADLs)
- Charges for missed appointments
- Dental care
- Cosmetic surgery
- Medical services provided outside of the United States
- TV rentals and VCRs in hospital rooms, as well as meal trays and cots for guests
- Respiratory therapy, speech therapy, and occupational therapy
- Services provided to people in prison or jail
Example: Jessie qualified for Medicaid and thought all her medical needs would be covered. However, her claims for her yearly physical and her over-the-counter allergy pills were denied. She also missed several doctor’s appointments. She was charged because she did not cancel in advance. Jessie had to pay for the missed appointments. She learned the hard way about services not covered by Medicaid.
Medicaid may pay for optional medical services like:
- Eye examinations, glasses, contact lenses
- Hearing exams and aids
- Preventive screenings
- Physical therapy
- Nonemergency transportation to and from medical appointments and treatments
- Some non prescription drugs and nonprescription drugs not covered by Medicare
- Chiropractic care
Fred needed physical therapy and chiropractic care to build his strength and help him get around a little easier. Medicaid typically does not pay for these services. However, Fred should talk to a Medicaid caseworker because some assistance may be available.
In addition, Medicaid does not pay for services provided by any health care provider who does not participate in Medicaid. Make sure your doctor accepts Medicaid patients before making an appointment.
Medicaid must consider Medical treatment and supplies medically necessary. For example, Randall feels he needs to move to a nursing home, but his doctor does not. Medicaid will probably deny Randall’s request unless his request is supported by documentation showing nursing care is medically necessary.
To receive Medicaid, you must be eligible.
The Medicaid application process is long, complex, and frustrating. In addition to the application, individuals must present many documents supporting their request for benefits. Applicants who are denied coverage can appeal the denial.
Act Now.
People should plan for long-term care and Medicaid eligibility well before incapacity strikes. In doing so, you should also know about services not covered by Medicaid.
The attorneys at Miller Estate and Elder Law help their clients prepare estate plans that address future potential incapacity issues. For a free consultation, contact us at 256-251-2137 or use our convenient Contact Form. Although we’re located in Anniston, we also help clients in the Birmingham, Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
