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tan253's avatar

What are the restrictions with being on low cost health care or medicaid?

Asked by tan253 (2869points) June 30th, 2012

I“m just wondering what you miss out on if you were to go on medicaid insurance.
Of course medicaid is an insurance for lower economic families/individuals – and for other health insurance you can pay a whooping amount every month, therefore in my mind people on a low costing insurance must get below standard health care?

What are the restrictions with an insurance like medicaid?

Do you get training Drs?
Not allowed certain tests?
What would make someone pay more for insurance if you can get free insurance?

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15 Answers

DrBill's avatar

you must be over 65, under 18, or have dependent children. The amount you pay is a spindown. You must spend down your money to the point of qualifying for a free card, which is good for one calendar month.

If your card is free it means you are at or below the poverty level for your area. If you have a $100 spindown, it means you make $100 over the poverty level in your area.

You do not get inferior medical help, the doctors are not told what insurance you have or don’t have, therefore it has no bearing on your coverage. what is covered depends on the doctors findings. i.e. if you have a broken leg, they will not pay to get you an arm x-ray etc

tan253's avatar

I“m on metro plus which is part of medicaid however it works and lasts for a year.
so the insurance you discuss above doesn’t sound like Medicaid?

I was told that I can only see Dr’s that accept Medicaid – which are few and far between.
I“m hoping to get a ‘better’ insurance (once I start working) but really unsure of my limitations with metro plus/medicaid and my daughters – but I was on medicaid before I had her.

bkcunningham's avatar

@tan253, you use Metro Plus. So that means you live in New York state, right? Here’s your plan:

Seaofclouds's avatar

There is a difference between Medicare (which sounds like what @DrBill is talking about) and Medicaid. Medicaid is for the low income families and there are certain eligibility requirements. As with any insurance, there are limitations as far as who you can see (such as seeing a doctor that accepts your insurance plan). Beyond that, the difference you see is usually minimal because the doctor’s have agreements with each insurance plan they accept as far as what they will and won’t get paid for. The things they won’t get paid for from your insurance company, they most likely know about in advance and they wouldn’t try them, instead they’d go with things they will get reimbursed for.

Aethelwine's avatar

It can be difficult to find a doctor in your immediate area who accepts Medicaid and you usually don’t have that many doctors to choose from.

There are times when interns are allowed to assist the doctors. This happened to me several times when I was pregnant with my second son and I was on Medicaid. There were many times when interns were present during my office visits. An intern was also allowed to perform my episiotomy. As he was cutting me I heard him whisper “oops!”. He cut too far. That was a painful recovery. :/

One restriction I am aware of is treatment for nail fungus is not covered because it is considered a cosmetic treatment. This happened to someone in the family over 8 years ago so I’m not sure if that restriction has been lifted or if the restriction is just specific to Illinois. Oral medication at the time was over $800 so the fungus was left untreated.

tan253's avatar

oh my goodness @jonsblond that sounds horrible!
Did you agree to let the intern do that or did they do it without your consent?!

Yeah so I guess their are restrictions – the more you pay the more you’re covered I guess?
Sounds like medicaid doesn’t take to well to preventive medicine.

bkcunningham's avatar

Are you in New York, @tan253? I think Medicaid options vary by county in NY.

Aethelwine's avatar

@tan253 They did ask for my approval. I couldn’t say no. (your baby is adorable!)

lynzeut's avatar

Ok, maybe I haven’t experienced anything crazy with Medicaid yet, but so far I haven’t seen any major differences to that of a regular insurance provider.

Do you get training Drs.? my experience, that would be something more related to the facilities that you visit. I.e. a learning hospital or a practice where students are allowed to do rotations. When I visit my pediatrician, he regularly has PA-S or NP-S in his office. I am always asked if it is ok for the to see me before they do any kind of work over (so you can always say “NO”) However I have been to facilities where they do not have an open door policy for students. Also, when I was insured by a private health care provider, I was seen by more students than I ever have been since receiving Medicaid.

Not allowed certain test?...I would assume a Doctor could not refuse you test if they are medically needed, and I couldn’t imagine Medicaid not paying for something that was medically necessary..

What would make someone pay more for insurance if you can get free insurance?... I know Medicaid varies from state to state, but where I live if you are able to receive insurance through an employer, school or under a parent, you do not qualify. Also, if I make over $500 a month I would no longer qualify. And no health insurance is worth making less than $500 a month IMO.

bkcunningham's avatar

I got a little confused, @lynzeut. Are you on Medicaid now? The last sentence threw me.

lynzeut's avatar

Yes, I am.

Rarebear's avatar

Okay, just to clear a few things up.

1) Medicaid is for poor people, not elderly over 65. That’s Medicare. Different.

2) Interns don’t just work on poor people. There are residency programs in many different hospitals, some public hospitals and some private hospitals. I know many rich private hospitals that have residency programs.

3) Teaching programs are often more up to date than hospitals without teaching programs, because they have to be to teach. We have several local hospitals that don’t have teaching programs and they are terrible.

4) The reason why many private doctors will not take Medicaid is that Medicaid pays very little on the dollar. The only way a system can possibly survive on Medicaid is if they get special waivers by serving an underserved community.

bkcunningham's avatar

@Rarebear, how does the waiver work? I’m sure it is very complex, but if you could just give me enough basic information to look up more on the subject myself, I would appreciate your help.

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