Medicaid covers doctor visits, hospital stays, and prescription drugs, but the exact list depends on your state
Medicaid is a joint federal and state program, which means each state decides what services to cover within federal minimums. All states must cover certain basics: doctor visits, hospital inpatient and outpatient care, emergency services, lab work, X-rays, and nursing home care for people over 21. Most states also cover prescription drugs, mental health services, and preventive care like vaccines and screenings. But whether Medicaid covers dental work, vision care, hearing aids, or physical therapy varies by state and sometimes by which Medicaid program you're in.
The fastest way to know what your state covers is to call your state Medicaid office directly or visit its website. You can also ask when you apply or after you're enrolled. Many states publish a document called a "state plan" or "benefits guide" that lists covered services line by line.
Key Takeaways
- All states cover doctor visits, hospital care, emergency services, and lab work through Medicaid, but coverage of dental, vision, and hearing services varies by state.
- Your state Medicaid office publishes a benefits guide that lists exactly what is and isn't covered in your state.
- Some services require prior authorization from Medicaid before your doctor can provide them, which means your doctor must ask permission first.
- If Medicaid denies coverage for a service your doctor says you need, you have the right to request a review of that decision.
Services all states must cover
Federal law requires every state Medicaid program to cover inpatient hospital care, outpatient hospital services, emergency services, physician services (including office visits), laboratory services, X-ray services, and skilled nursing facility care for people 21 and older. This means if you have Medicaid in any state, you can see a doctor, go to the hospital, and get lab work done without that service being denied simply because it's not covered.
Preventive services are also mandatory across all states. This includes routine physical exams, vaccinations, screening tests for cancer and heart disease, and family planning services. You typically pay nothing out of pocket for preventive care — no copay, no deductible.
Services that vary by state
Dental care is one of the biggest variations. Some states cover routine dental cleanings and fillings for adults; others cover only emergency dental care like extractions. A few states cover almost no adult dental services at all. Children's dental care is more widely covered, but the scope still differs.
Vision care and hearing aids follow the same pattern. Some states cover eye exams and glasses; others cover only exams. Hearing aid coverage ranges from full coverage to none. Physical therapy, occupational therapy, and speech therapy are covered in most states but may have limits on the number of visits per year. Prescription drug coverage is nearly universal, but each state maintains a list of covered medications called a formulary, and some drugs may require your doctor to request prior authorization.
Mental health and substance use treatment are covered in all states, but the scope varies. Some states cover unlimited outpatient therapy; others limit visits per year. Inpatient psychiatric care is covered in all states for people under 65, but coverage for people 65 and older is restricted by federal law.
How to find out what your state covers
Start with your state Medicaid website. Search "[your state] Medicaid benefits" or "[your state] Medicaid covered services." Most state websites have a searchable benefits guide or a phone number to call. When you call, have your Medicaid number ready if you already have one, and ask specifically about the services you need.
If you're applying for Medicaid, the application materials usually include a summary of covered services. If you're already enrolled, your Medicaid card or welcome packet should have contact information for your state program. Some states also use managed care organizations to deliver Medicaid, which means your coverage may depend on which plan you're in — in that case, call your specific plan's customer service number.
Prior authorization and when your doctor must ask permission first
Many covered services require prior authorization, meaning your doctor must contact Medicaid and get approval before providing the service. This is common for specialist visits, imaging like MRIs, surgeries, and certain medications. If your doctor doesn't get prior authorization and Medicaid hasn't approved the service, you may be billed for it.
Your doctor's office usually handles prior authorization requests, but it's worth asking them directly: "Does Medicaid require prior authorization for this?" If they say yes, ask them to submit the request before your appointment. If the request is denied, your doctor can appeal or you can request a review yourself.
What happens if Medicaid denies a service
If Medicaid says it won't cover something your doctor says you need, you have the right to request a review, called an appeal or reconsideration depending on your state. The process usually starts with a written request to your state Medicaid office within a time limit — often 30 to 60 days from the denial letter. Include a letter from your doctor explaining why the service is medically necessary.
Some states allow you to request an expedited review if the delay would harm your health. During the review, a Medicaid official or independent reviewer will look at your case again. If you disagree with the outcome, most states allow a second level of appeal. Your state Medicaid office can tell you the exact steps and deadlines for your state.
Services Medicaid does not cover
Medicaid does not cover cosmetic procedures, experimental treatments not yet approved by the FDA, or services provided outside the United States. Long-term care in your home (like a home health aide for personal care rather than medical care) is covered in some states but not others. Dental implants, orthodontia, and most vision correction surgery are typically not covered. Over-the-counter medications are not covered, though some states cover certain OTC items like nicotine patches if prescribed by a doctor.
Medicaid also does not cover services from providers who are not enrolled in Medicaid. If you see an out-of-network doctor or use an out-of-network pharmacy without authorization, you may have to pay out of pocket. Always check whether your provider accepts Medicaid before your visit.
Frequently Asked Questions
Does Medicaid cover therapy or counseling?
Yes, mental health and substance use treatment are covered in all states. Coverage includes outpatient therapy, psychiatry, and inpatient treatment. The number of visits per year and whether you need prior authorization varies by state and plan.
Does Medicaid cover prescriptions?
Nearly all states cover prescription drugs through Medicaid. Each state maintains a formulary — a list of covered medications. If your doctor prescribes a drug not on the formulary, your doctor can request an exception, or you may pay out of pocket. Some drugs require prior authorization.
Does Medicaid cover dental work for adults?
It depends on your state. Some states cover routine cleanings, fillings, and extractions. Others cover only emergency dental care. A few cover almost nothing for adults. Call your state Medicaid office or check your state's benefits guide to find out what your state covers.
Does Medicaid cover glasses or contacts?
Coverage varies by state. Some states cover eye exams and one pair of glasses per year for adults. Others cover exams only. Contact lenses are rarely covered. Check your state's benefits guide or call your state Medicaid office to confirm what's covered where you live.
What do I do if my doctor says I need something Medicaid won't cover?
Ask your doctor to submit a prior authorization request or appeal on your behalf, explaining why the service is medically necessary. If Medicaid still denies it, you can request a formal review. Your state Medicaid office can explain the appeal process and deadlines for your state.