What is the difference between Medicaid and Medicaid expansion?
Asked by: Aaliyah Lindgren | Last update: August 19, 2025Score: 4.9/5 (69 votes)
Who benefits the most from Medicaid expansion?
Medicaid expansion is associated with improvements in overall self-reported health among adults with low incomes. Among people with chronic disease, it is associated with improved access to care, better health outcomes and disease management, and decreased mortality.
What is the downside of Medicaid expansion?
KEY FINDINGS. More than 5.8 million Americans would be forced off private insurance and onto welfare if the remaining states were to expand Medicaid. This crowd-out alone would exceed $8 billion. Expansion has harmed hospitals and providers, forcing millions off private insurance and onto welfare, which pays less.
What is the highest income to qualify for Medicaid 2024?
Parents of Dependent Children: Income limits for 2024 are reported as a percentage of the federal poverty level (FPL). The 2024 FPL for a family of three is $25,820. Other Adults: Eligibility limits for other adults are presented as a percentage of the 2024 FPL for an individual is $15,060.
How often does Medicaid check your bank account?
Medicaid agencies can check your account balances for bank accounts at any financial institution you've used in the past five years. They will check when you submit an application and on an annual basis, but checks can occur at any time.
The Medicaid Expansion and Its Effects
Will I lose my Medicaid if I get Medicare?
People who have both Medicare and full Medicaid coverage are “dually eligible.” Medicare pays first when you're a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.
How does Medicaid expansion differ from Medicaid?
Under the expansion guidelines, Medicaid eligibility is extended to adults under age 65 with incomes up to 138% of the federal poverty level/FPL (133% plus a 5% income disregard). Pre-ACA, Medicaid was generally never available to non-disabled adults under age 65 unless they had minor children.
What states haven't expanded Medicaid?
The Affordable Care Act, also known as Obamacare, was enacted in 2010, but 10 states have not expanded Medicaid, the federal-state program that provides health care for low-income people. They are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.
Is Medicaid expansion expensive?
State officials estimated that expansion would be accompanied by a price tag of nearly $55 billion by 2023, but actual costs have surpassed $203 billion—a cost overrun of 271 percent.
Who does Medicaid expansion cover?
The Affordable Care Act's (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,783 for an individual in 2024) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations.
Which is better, Medicaid or Obamacare?
Since Medicaid is intended for those with very low incomes, anything other than token small amounts of cost-sharing would be unaffordable to Medicaid recipients and present a potential barrier to care. On the other hand, Obamacare health plans often come with substantial deductibles, copayments, and coinsurance.
Can you have Medicaid and marketplace insurance at the same time?
Keeping both Marketplace and Medicaid and CHIP
If you have qualifying health coverage through Medicaid or CHIP coverage, you'll pay full price for your Marketplace plan premium and covered services.
What is not covered by Medicaid?
Medicaid coverage can vary from state to state, but here are some common services and items that are typically not covered: Elective cosmetic procedures: Cosmetic surgeries and procedures, such as cosmetic dentistry and non-medical weight loss procedures, that are not medically necessary are typically not covered.
What happens if you make too much money while on Medicaid?
If you're over the Medicaid income limit, some states let you spend down extra income or place it in a trust to help you qualify for Medicaid. If you receive long-term care but your spouse doesn't, Medicaid will allow your spouse to keep enough income to avoid living in poverty.
What is the income limit for Medicaid expansion?
The ACA expanded Medicaid to nonelderly adults with income up to 138% FPL ($20,782 annually for an individual in 2024) with enhanced federal matching funds (now at 90%).
What are the hardest states to get Medicaid?
The 10 most deficient state programs have overall scores ranging from between 317.8 and 379.1 of the total 1000 points. The worst, in order from 50th to 41st, are in Mississippi, Idaho, Texas, Oklahoma, South Dakota, Indiana, South Carolina, Colorado, Alabama, and Missouri.
What are the four types of Medicaid?
- State-operated fee-for-service (FFS)
- Primary care case management (PCCM)
- Comprehensive risk-based managed care (MCO model)
- Limited-benefit plans.
Can you have Medicare and Medicaid expansion?
In total, 12 million people are "dually eligible" and enrolled in both Medicaid and Medicare, composing more than 15% of all Medicaid enrollees. Individuals who are enrolled in both Medicaid and Medicare, by federal statute, can be covered for both optional and mandatory categories.
What happens when you are on Medicaid and turn 65?
Therefore, following the ACA's coverage expansion, many newly-insured older enrollees will face a complex insurance transition on their 65th birthday: they will lose Medicaid coverage and transition from Medicaid to Medicare as their primary insurer.
Is it better to be on Medicare or Medicaid?
While Medicare is the primary payer for medical needs, Medicaid can cover costs that Medicare coverage does not. When you visit a provider that takes both Medicare and Medicaid, Medicare pays first for the cost of your care. Medicaid pays second, covering copays and other costs not covered.
Who gets both Medicare and Medicaid?
Medicare-Medicaid enrollees include people ages 65 and over who are in relatively good health but have limited financial resources and people who at one time, may have had more financial resources, but spent their income and wealth on health or long-term care costs.