What to Know About Medicaid During Cancer Treatment

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What is Medicaid?

If you’re a little confused about the basics of Medicaid, you’re not alone! It’s a very complex system. 

Medicaid is a federal program that’s administered by the states. Each US state has its own policies and guidelines, so the patient experience can differ a lot from place to place. There are also state-level differences in who’s eligible for Medicaid. (More on that shortly.)

Note that the various US states offer Medicaid under different names. In California, it’s called Medi-Cal; in Maine, it’s called MaineCare; in Massachusetts, it’s MassHealth; and so on. Check this list to see what it’s called in your state.

Who can get Medicaid?

Medicaid exists to serve low-income people. Older people (over 64), pregnant women, and people with disabilities are always eligible. In addition, if you’re receiving SSI (Social Security Income) for a disability, you’re almost certainly eligible for Medicaid (you just might need to take some extra steps to sign up versus being automatically signed up in your state). If you’re receiving SSDI (Social Security Disability Insurance) you may or may not be eligible (most likely not).

As we mentioned above, different states have different ways of deciding who’s “low-income” and who’s not, but these calculations typically measure your income relative to the Federal Poverty Level. They may also take your savings and other assets into account. Generally speaking, if you’re facing financial hardship, there’s a good chance you’ll be covered.

Not sure if you’re eligible for Medicaid? Apply anyway. Many states have special Medicaid programs in place that serve people with disabilities, undocumented immigrants, women with breast and cervical cancer, and so on. These programs might have different names (like “Emergency Medicaid”) and may accept patients who’d be ineligible for standard Medicaid. The programs are also not all the same, and the amount of assistance you might receive if can vary greatly.

Note that many states have adjusted their eligibility requirements due to “Medicaid Expansion.” So even if you were previously turned down by your state Medicaid program, it may be worth applying again.

Generally speaking, Medicaid covers your entire cancer treatment journey—from diagnosis and medication to surgery, hospitalization, and follow-up care. 

There are some limitations. Dental care is limited, and you might need to get generic medications rather than the brand-name versions. But these are similar limitations to the ones you’ll find in any private health insurance policy.

Occasionally, if your doctor orders a new, expensive treatment, Medicaid might refuse to pay for it. But in these cases, your doctor can push back. They’ll submit documentation to Medicaid showing that the treatment is medically necessary. Medicaid will often change course and pay for your treatment.

How much does it cost?

If you’re a higher-income Medicaid recipient, you may need to pay a “deductible” or “spend down” monthly that you have to meet before Medicaid starts paying. This is typically a flat dollar amount. Sometimes Medicaid will pay for an employer’s monthly premium if you’re offered insurance at work, while Medicaid picks up the rest. (This is called coinsurance.) But for people earning less, it’s virtually free. You may have to pay a few dollars (your “copay”) when you see a doctor or pick up a medication—typically less than $10. But many basic services (such as seeing your primary care doctor) are 100% free.

Which doctors take Medicaid?

Unfortunately, there’s no easy answer to this question. Some healthcare providers accept Medicaid and some don’t, and there’s no single place where this information is listed. You can try using a service like Zocdoc or Doctor.com to find a nearby doctor who accepts Medicaid, but these sites aren’t always complete. You can, however, always contact a doctor or treatment center you’re interested in and ask them if they accept Medicaid.

In some states, Medicaid requires patients to register with an HMO. That means you can only see the healthcare providers in one particular group. So before you get healthcare, check with both the doctor and your Medicaid provider to make sure the treatment will be covered!

What’s my next step?

Cancer treatment can be a very challenging experience, and the last thing you should have to worry about is your finances. If you’re ready to apply to Medicaid, you can find your state office here and get started. You can also talk to a social worker or a benefits specialist at your local Aging and Disability Resource Center (ADRC) for help navigating the system.

If you’re already in cancer treatment with Medicaid, be sure to open all official mail from your Medicaid provider. The state will periodically review your case and make sure you’re still eligible to receive benefits—and you don’t want to lose coverage just because you didn’t fill out a form. If family or friends offer to help, you may want to ask one person to handle your mail, just to ensure nothing falls through the cracks. Again, cancer treatment can be a difficult time. The more support you have, the better off you’ll be.

The content on this website is intended to provide the best possible information for you, but should not be considered—or used as a substitute for—medical advice. If you have questions about your diagnosis or treatment, please contact your health care provider(s). For questions or comments about this content, please email us at [email protected].