Medicaid covers doctor visits, hospital stays, and prescription drugs, but the exact list depends on your state and which Medicaid program you're in
Medicaid is not one program — it is a partnership between the federal government and each state, so what your state's Medicaid covers can differ from what another state covers. Every state must cover certain basics: doctor visits, hospital inpatient and outpatient care, emergency services, lab work, X-rays, and family planning. Beyond that, states choose what else to include. Some cover dental care and vision; others do not. Some cover physical therapy; others limit it. Your state's Medicaid program publishes its own list of covered services, and that list is what matters for your situation.
The coverage you get also depends on which Medicaid category you fall into. Medicaid for parents works differently from Medicaid for seniors, which works differently from Medicaid for people with disabilities. A service might be covered under one category and not another. This is why checking your own state's rules and your own enrollment category is the only way to know for certain what you can use.
Key Takeaways
- Every state's Medicaid must cover doctor visits, hospital care, emergency services, lab work, and X-rays, but states add or remove other services on their own.
- What Medicaid covers depends on which state you live in and which Medicaid category you enrolled in — parent, child, senior, or disability.
- Prescription drugs, dental care, vision care, and mental health services are covered in some states but not others.
- Your state's Medicaid website or your caseworker can give you the exact list of what is covered under your specific enrollment.
Services every state's Medicaid must cover
Federal law requires every state Medicaid program to cover inpatient hospital care (staying overnight), outpatient hospital services (going to the hospital but not staying), emergency services, physician services (doctor visits), laboratory services and X-ray services, family planning services and supplies, and nurse midwife services. These are the floor — the absolute minimum. If you have Medicaid, you can count on these services being covered no matter which state you live in.
Beyond these required services, states can and do add coverage. Some states cover dental care for adults; others cover it only for children. Some cover vision exams and glasses; others do not. Some cover hearing aids; others do not. Some cover physical therapy and occupational therapy; others limit these services or do not cover them at all. This is where your state's specific rules matter.
Prescription drugs and pharmacy coverage
Medicaid must cover prescription drugs, but each state decides which drugs are on its list and how many you can get per month. Your state maintains a formulary — a list of approved medications — and it changes throughout the year. If your doctor prescribes a drug that is not on your state's formulary, Medicaid may not cover it, or your doctor may have to request an exception from your state's Medicaid program.
Some states limit how many prescriptions you can fill in a month, usually between 3 and 5. If you take more medications than your state allows, you may have to pay out of pocket for the extras, or your doctor can request an override. The pharmacy you use also matters — not all pharmacies accept Medicaid, so you may need to use a pharmacy in your state's network.
Mental health and substance use treatment
Medicaid covers mental health services and treatment for substance use disorder, but the scope varies by state. Most states cover therapy or counseling with a licensed therapist, psychiatrist visits, and inpatient psychiatric hospitalization. Some states cover a limited number of therapy sessions per year; others do not limit them. Some cover medication-assisted treatment for opioid addiction; others do not.
If you need mental health or addiction treatment, ask your state's Medicaid program or your caseworker what is covered in your state and whether you need a referral from your doctor. Some services require prior approval from your state before you can use them, which means your provider has to ask permission first.
Dental, vision, and hearing services
Dental care for adults is optional for states, so coverage varies widely. Some states cover cleanings, exams, and basic fillings. Others cover nothing for adults. Most states cover dental care for children because federal law requires it. Vision care — eye exams and glasses — is also optional for states. Some cover both exams and glasses; others cover exams only; others cover nothing. Hearing aids and hearing exams are similarly optional, and many states do not cover them.
If you need dental, vision, or hearing services, check your state's Medicaid website or call your caseworker to find out what is covered. If your state does not cover a service you need, you may be able to find low-cost or free clinics in your area through your local health department.
Long-term care and nursing home coverage
Medicaid is the largest payer for nursing home care in the United States. If you need to live in a nursing home and cannot afford it, Medicaid can cover the cost, but rules about how long you can stay and what you pay vary by state. Medicaid also covers some home and community-based services — help at home instead of in a facility — but availability and what is covered depends on your state and whether you meet the state's criteria.
Medicaid does not cover assisted living facilities in most states, though some states have special programs. If you or a family member may need long-term care, contact your state's Medicaid program or your local Area Agency on Aging to learn what options are covered in your state.
Services Medicaid typically does not cover
Medicaid does not cover cosmetic surgery, most dental work for adults (in states that do not cover it), most vision care for adults (in states that do not cover it), hearing aids (in most states), weight loss surgery, fertility treatments, or experimental treatments not yet approved by the FDA. Medicaid also does not cover services from providers outside the United States, and it does not cover services from providers who do not accept Medicaid.
If your doctor recommends a service you think Medicaid should cover, ask whether it is covered before you receive the service. If Medicaid denies coverage, you have the right to appeal the decision. Your state's Medicaid program can tell you how to file an appeal.
How to find out what your state covers
The fastest way to learn what Medicaid covers in your state is to visit your state's Medicaid website. Search "[your state] Medicaid covered services" or "[your state] Medicaid benefits." You can also call your state's Medicaid customer service line — the number is on your Medicaid card or on your state's Medicaid website. If you have a caseworker, they can tell you what is covered under your specific enrollment.
When you call or visit the website, have your Medicaid category ready — whether you are enrolled as a parent, child, senior, or person with a disability. The answer may be different depending on your category. If you need a specific service covered, ask whether your state covers it and whether you need a referral or prior approval from your doctor.
Frequently Asked Questions
Does Medicaid cover prescription glasses and contacts?
Vision coverage varies by state. Some states cover eye exams and glasses for all ages; others cover them only for children; others do not cover them at all. Contact your state's Medicaid program to find out what is covered where you live. If your state does not cover glasses, community health centers and nonprofit organizations often offer low-cost vision services.
Will Medicaid cover my dental work?
Dental coverage for adults is optional for states, so it depends where you live. Most states cover dental care for children. If your state does not cover adult dental care, ask your caseworker about low-cost dental clinics in your area. Some dental schools also offer reduced-cost care performed by students under supervision.
Does Medicaid cover therapy or counseling?
Yes, Medicaid covers mental health services including therapy and counseling, but the number of visits and types of providers covered vary by state. Some states limit sessions per year; others do not. Ask your state's Medicaid program or your doctor for a referral to a Medicaid-covered therapist in your area.
What happens if my doctor prescribes a drug Medicaid does not cover?
Your doctor can request an exception or appeal to your state's Medicaid program. This process is called a prior authorization request. Your doctor's office usually handles this. If the exception is denied, you can pay out of pocket or ask your doctor about a different medication that is covered.
Does Medicaid cover weight loss surgery?
Weight loss surgery is not covered by most states' Medicaid programs. Some states cover it only in specific medical situations. Contact your state's Medicaid program to ask whether it is covered and what conditions must be met. If it is not covered, ask your doctor about other options.