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Are you living in New York and looking to obtain health insurance for yourself or a loved one? Start by exploring New York Medicaid options to see if you're eligible and whether this plan could be a good fit.
What is New York Medicaid, and could it work for you? Understanding what this state’s medical insurance covers and doesn’t cover can help you determine whether joining the program could help you get the healthcare you need. It is an affordable program that can provide eligible individuals with free or inexpensive medical care coverage. As of March 2023, over 9 million New Yorkers were enrolled in the program.
This guide explores what this state’s Medicaid coverage involves. That way, you’ll know whether you need to boost these services by adding on private or third-party health insurance. Doing so could mean you spend far less on medical expenses and services that your main Medicaid insurance in New York might not provide. Many New Yorkers extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
The healthcare insurance that the state and the U.S. Department of Health and Human Services provide helps low-income adults and children access healthcare services at low costs or entirely for free. Depending on the criteria, some people will receive medical services, prescription coverage, long-term care for seniors, and more through this comprehensive program.
While Medicaid has no monthly premium, cardholders might still need to make small co-payments for some of the services they receive. However, your insurance will usually try to waive payments for those who can't afford them.
A New York Medicaid card indicates an insurance membership so that medical providers know you have coverage. Your Medicaid card will have a unique ID number that ties your name to the care and medical services you can receive. That’s why it’s important to keep your card with you for each healthcare appointment and request a new card as quickly as possible if you lose it.
If you're wondering how to apply for New York Medicaid, you have several options. Those who are eligible and part of a Modified Adjusted Gross Income group should apply through the NY State of Health and their online marketplace. If you are not part of the MAGI groups, you can visit your Local Department of Social Services (LDSS) office for in-person assistance or with a Facilitated Enroller for the Aged, Blind, and Disabled.
The primary ways of applying for New York Medicaid include the following:
New York residents or legal aliens wanting to join must fulfill the following Medicaid New York state eligibility requirements:
Your household income and size must also meet the New York Medicaid income limits. Intuitively, income limits expand based on the number of people in your household (the income limit for a household of one person is around 25% of what a household of eight will earn to qualify). If you'd like a more detailed figure, you can always check what your household size's income limit requirement is via the Benefits website.
New York’s Medicaid will still consider those with disabilities when their income is too high, and they don't have a certificate of disability from the SSA office. For example, you can receive a review to see if you are certified disabled by reaching out to the Local Department of Social Services.
You should receive your New York Medicaid card from the program that helped you apply. For instance, if you applied with the NY State of Health marketplace, they will send you a card in the mail. It's the same if you applied through a Local Department of Social Service.
Are you looking to renew or replace a lost Medicaid card? Call your LDSS office or apply online for a new card.
If you have Medicaid with the NY State of Health, you can contact their call center at 1 (855) 355-5777. Alternatively, connect with the HRA Medicaid Helpline at 1 (888) 692-6116 or the Human Resources Administration (HRA) Infoline at 1 (718) 557-1399 for any of the five boroughs.
Now that you have a better understanding of eligibility requirements and application, you should learn what New York Medicaid covers in its public health insurance plan.
New York offers dental care coverage for Medicaid patients, including regular exams, dental cleanings, X-rays, and more as seen below. Pediatric dental care helps children improve their oral health through multiple types of dental care, such as preventative care, routine and major services, and orthodontia. Emergency dental care services for children are also a part of the covered care that the New York Medicaid program provides. New York Medicaid covers the following dental services without preauthorization:
While the dental coverage offered by Medicaid NY is extensive, it may not provide enough coverage for those who have more serious dental problems; and anticipate requiring more trips to the dentist. To be fully covered, consider investing in private dental plans in New York.
Medicaid in New York covers prescription and non-prescription drugs for cardholders. The New York State Medicaid Pharmacy Program (called NYRx) will support medically necessary prescriptions and over-the-counter drugs.
Some medications require prior approval from your healthcare provider. Check out the New York Medicaid preferred drug list to see which prescriptions have coverage and how this applies to you. If you are looking for more information about Medicaid's pharmacy program or have questions, you can also call (518) 486-3209 or email ppno@health.ny.us (with "Preferred Drug Program" as the subject line).
Third-party or private coverage on top of Medicaid can help cover what your primary plan might not.
New York’s Medicaid also offers extended healthcare services to support individuals with disabilities and seniors. The additions include nursing homes and community-based long-term care services, and support for the blind and disabled. Mental health services, including psychiatric care, also help Medicaid members receive the care they need in New York.
Many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
The only time New York Medicaid will cover out-of-state care is if a member is facing a medical emergency and requires immediate assistance. Any type of care that they can receive in the state and choose to seek elsewhere will not fall under covered services.
Additionally, if you are moving to a new state, you'll need to cancel your enrollment in New York’s Medicaid program and follow the application process for your new location. You can typically have retroactive coverage for a maximum of three months while waiting for your approval.
If you’re thinking of going out of New York for treatment, private or third-party insurance may help when you need out-of-state care or services that aren't deemed medically necessary. It helps you seek treatment from providers that are outside of your network or enjoy more holistic care that Medicaid often doesn't cover. If you are traveling outside of Florida for leisure, invest in proper travelers insurance.
New York has many college students coming from out of state and looking for medical coverage as a university requirement. For this reason, the NY State of Health partners with several colleges to help students enroll in Medicaid or another plan. With this support network, applicants can obtain free or low-cost coverage to meet their school's requirements and receive the medical services they need while they're a student in New York.
On the other hand, New York’s senior population over 65 can receive varying levels of medical assistance. For example, they may opt for at-home care services or need care within designated care facilities that assist with daily medical support and living support.
Some of the most popular senior care services in New York include:
When you or a loved one requires daily at-home care or medical assistance outside the home, you will likely qualify for Medicaid in New York if you meet the income requirements. Blind or disabled individuals who are also seniors should receive care through Medicaid as well as accessing caregiving support if necessary.
Besides providing quality care and health support to students, seniors, and individuals who are disabled, the state of New York and Medicaid offer assistance to American Indians, military members, and veterans. If Medicaid does not supply specific coverage, other resources from the state can fill in the gaps for healthcare or financial support.
American Indians can receive healthcare coverage through New York’s Medicaid if they meet the program’s eligibility requirements. However, they also can obtain healthcare support through the American Indian Health Program, which provides care to nine recognized tribes. These covered services include standard medical care, dental care, and health education.
The main services that American Indians can receive through this program include the following:
Members of the military, veterans, or their children are potentially eligible for New York Medicaid. They can also work with the U.S. Department of Veterinary Affairs, the NY State of Health Essential Plan, or other veteran resources. However, low-income individuals often qualify for Medicaid.
Have you or a loved one served in the United States Armed Forces in some capacity and are now looking for insurance coverage? You can visit the NY State of Health marketplace or an LDSS office for assistance in sifting through the options on offer. Take the first step and fill out an application form; it's the best way to determine whether you are eligible for the program or better suited for another type of plan that's on offer.
Medicaid services in New York have some limitations and restrictions on what services they cover based on the member's age, financial situation, living arrangements, and other details. For example, while Medicaid in New York will cover medically necessary services, dental care, and many other types of healthcare services, it does not cover the following:
You receive a Benefit Identification Card that can help you see what items and services you have coverage for. If you are uncertain, contact NY State of Health or your LDSS office to learn more.
New York residents can receive a wide range of services as Medicaid members, ranging from dental and vision to mental health support.
| Dental | |
|---|---|
| X-Rays and Exams | New York’s Medicaid program covers standard dental checkup visits and emergency care for adults and children to help prevent long-term oral health issues. These preventative care services include x-rays, repairs, and cleanings. |
| Wisdom Teeth | The insurance may cover the removal of wisdom teeth if medically necessary. Wisdom teeth extractions depend on your plan details and eligibility. |
| Vision | |
|---|---|
| Eye Exams | Visits to the eye doctor every two years are a part of your New York Medicaid benefits. If you have an eye condition that requires frequent exams, you'll need a claim form to show the proper documentation. |
| Glasses | With New York's Medicaid coverage you should be able to receive medically necessary eyeglasses and contact lenses. However, the details of your insurance coverage may depend on what your optometrist recommends. |
| Laser Eye Surgery | Might surgery be necessary for the health of your eyes? New York's Medicaid may cover laser eye surgery with your healthcare provider's approval. However, if it is possible for you to pursue other options for your optic health, your insurance is highly unlikely to provide coverage. |
| Surgery | |
|---|---|
| Rhinoplasty | You cannot use Medicaid for elective nose jobs in New York. If it is medically necessary, you could potentially receive coverage. However, aesthetic surgeries will require you to pay out of pocket. |
| Breast Reduction | While Medicaid will not cover a breast reduction for aesthetic or personal reasons, you could receive assistance if it is health-related. If your medical provider confirms that breast size is negatively affecting your health, you may receive approval. |
| Hospital | |
|---|---|
| Hospital stays | Medicaid will cover inpatient and outpatient hospital visits, potentially including psychiatric hospitals. |
| Ambulance transportation | Emergency transportation to the hospital via ambulance also falls under Medicaid benefits. |
| Giving birth | Pregnant women can receive information and healthcare services before, during, and after they have their baby for up to at least a year. They also may schedule routine pregnancy checkups and exams to assess their health and their baby's health. |
Medicaid in New York includes mental health and substance abuse disorder services. You can work with a therapist or mental health counselor who accepts Medicaid, but this arrangement typically requires prior approval and authorization from your primary healthcare provider.
Check the details of your Medicaid or Managed Care Organization plan to see what you need to do to apply for approval.
| Sexual Health | |
|---|---|
| Gynecologist | Women looking for gynecological services can receive care by providers that accept Medicaid. It generally covers services relating to reproductive health, such as mammograms and pap smears. |
| Erectile Dysfunction | Medicaid in New York will not cover erectile dysfunction treatment or medication. A possible situation where Medicaid could cover ED medication is if the medication is necessary (and FDA-approved) to treat another condition. |
| Birth Control | Medicaid covers all types of birth control, such as pills, condoms, diaphragms, IUDs, and more. Sterilization, emergency contraception, pregnancy tests, and STD testing are also free and confidential for New York Medicaid members. |
| Fertility Treatment | States do not often offer coverage for fertility or infertility treatments, but New York is one state that does. You become eligible for infertility services, fertility preservation services, and surrogacy services based on your Medicaid plan. |
| Specialist Services | |
|---|---|
| Dermatology | Many dermatologists in New York will accept Medicaid to provide exams and assess you for skin diseases and conditions. Medicaid sees aesthetic skincare treatments as elective and does not count them under the provided services. |
| Physiotherapy | New York’s Medicaid could support your physiotherapy treatments if your provider deems it medically necessary for treatment for sports injuries or chronic pain. |
| Massage Therapy | Typically, New York’s Medicaid coverage does not include massage therapy. Physical and occupational therapies may feature, but massages will be an out-of-pocket, elective service. |
| Podiatry and Foot Care | Medicaid in New York covers medically necessary foot care treatments for diseases and injuries. Foot care issues related to alcoholism, diabetes, multiple sclerosis, and more will also fit under New York Medicaid's coverage. |
| Allergy Testing | Medicaid usually covers allergist care, allergy testing, and diagnosis. Learn more about your benefits through your provider and see whether the allergy services you need fall under your plan. Some services depend on your age, location, income, or family situation, so it's a good idea to ask before scheduling an appointment. |
| Sleep Physician Services and CPAP Machines | If your medical provider signs off on sleep disorder treatment or testing, Medicaid could cover the services that go along with it. You may receive coverage for a trial run of a CPAP machine or for a CPAP machine you use on a daily basis. Talk to your primary provider if you are concerned that a sleep disorder is affecting your daily life or health. |
Medicaid may provide other services that aren't listed above. Healthcare providers across a wide range of services accept Medicaid as insurance for their patients, so you might have coverage for care you didn't even know about. You’ll find some of the best resources to understand your benefits at your Local Department of Social Services, primary care doctor, or the NY State of Health.
What is New York Medicaid coverage like for those who are relying on it for disability coverage or chronic conditions? If you aren’t sure whether this plan will cover your needs, you can always opt to top it up with private or third-party insurance for additional money-saving benefits and resources. That way, you gain access to services that Medicaid may not cover or specialists outside your network who provide the care you require.
You don't have to worry about an enrollment cap from the Medicaid program in New York when you have extra coverage from a private or third-party provider. You can also receive prescriptions and holistic, cosmetic, or aesthetic services that your Medicaid program may consider elective or not medically necessary. Instead of going without the care you need or want in New York, getting third-party coverage will top-off your Medicaid plan's scope with outside insurance for well-rounded care. You can use private insurance providers to fill the gaps in your AHCA Florida Medicaid plan and get the coverage you need. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
If you're ready to make the best decision for your healthcare needs, Insurdinary would like to help you explore New York health insurance options, including New York Medicaid and the many third-party plans available. Obtain your free quotes today or peruse our website for other types of insurance information and coverage details.
Eligibility for New York Medicaid is determined based on factors such as income, household composition, and other considerations. Generally, the program extends coverage to low-income individuals, families, pregnant women, children, elderly individuals, and those with disabilities.
New York Medicaid is a program designed to offer medical coverage to eligible low-income residents of the state. Funded through a combination of federal and state resources, its purpose is to ensure access to essential healthcare services for qualifying individuals.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
