Do You REALLY Know What Medicaid Covers for Seniors

For many older adults, Medicare doesn’t cover everything. That’s where Medicaid steps in — often quietly, but with big impact. Across the country, state programs are filling coverage gaps for dental care, hearing aids, eyeglasses, incontinence supplies, and even rides to the doctor’s office.

But with government assistance itself now in a state of “if” — tied up in shutdown negotiations and budget disputes — seniors are being urged to review their state’s coverage and confirm eligibility sooner rather than later. If federal funding for enhanced Medicaid programs stalls, experts say states may scale back optional benefits first — the very ones older adults rely on most, such as dental, hearing, and transportation assistance.

Medicaid benefits aren’t the same everywhere. Some states offer robust coverage with few limits; others stick to basics like preventive dental or one pair of glasses every two years. But every state provides at least a handful of core services that can make life easier and more affordable for seniors on fixed incomes.

Editor’s Note: Medicaid benefits listed below reflect 2025 state filings as of November 10, 2025. If Congress fails to extend federal support, some programs may change or pause during the year. Always verify with your state Medicaid office or plan provider before renewing coverage.

Hearing Aids

What’s covered: Exams; hearing aids (1–2 every 3–5 years); batteries and repairs.
Where: IL, NY, MN, OH, OR, WA, VT, MA, ME and others.
How to qualify: Audiologist evaluation + medical-necessity documentation.

Pro Tip: Ask for approved digital models — many states now allow mid-range Bluetooth devices under Medicaid.

Vision & Eyeglasses

What’s covered: Routine exams; frames/lenses every 1–2 years; lens replacement for breaks.
Where: Most states via managed-care vision partners (CA, NY, OH, NC, FL).
How to qualify: Vision prescription from an approved provider.

Pro Tip: Ask if “low-vision aids” are included — some plans cover magnifiers and adaptive devices.

Incontinence Supplies

What’s covered: Adult briefs, pull-ons, underpads, and sometimes gloves or wipes.
Where: 40+ states including KY, CA, FL, NC, OH, WA and TX.
How to qualify: Doctor’s diagnosis of incontinence + prescription.

Pro Tip: Many states ship monthly supplies automatically through vendors like Aeroflow or Medline.

Home & Community-Based Services (HCBS)

What’s covered: In-home personal care, respite, and limited home modifications.
Where: All states (via Medicaid waivers) but benefits vary.
How to qualify: Functional assessment + income/asset limits.

Pro Tip: Ask about “participant-directed” options — you may be able to hire a family member as your caregiver.

Therapy & Mental Health

What’s covered: Counseling, substance-use-disorder treatment, physical/occupational therapy.
Where: Nationwide via Medicaid and managed care.
How to qualify: Physician referral or behavioral screening.

Pro Tip: Telehealth is often fully covered — ask if virtual visits qualify.

Dental Care

What’s covered: Exams, cleanings, X-rays, fillings, extractions; dentures in some plans.
Where: 30+ states offer adult dental benefits through Medicaid (varies widely).
How to qualify: Enrollment in state Medicaid or a managed-care dental plan.

Pro Tip: If your state is “preventive-only,” book both cleanings early to stay eligible for broader benefits later.

Transportation to Appointments (NEMT)

What’s covered: Rides to medical visits, pharmacies and testing; some mileage reimbursement.
Where: All states offer NEMT under Medicaid (brokered through state vendors).
How to qualify: Be enrolled in Medicaid and schedule in advance via your plan’s transport line.

Pro Tip: Schedule recurring rides (PT, dialysis, etc.) in one call to lock your calendar for the month.

Podiatry & Foot Care

What’s covered: Exams, nail/callus care when medically necessary; diabetic foot care supplies.
Where: Common in Medicaid and managed-care plans for diabetes or circulation issues.
How to qualify: Physician/podiatrist diagnosis; periodic visit limits may apply.

Pro Tip: Diabetic members may qualify for one pair of therapeutic shoes plus inserts each year with a doctor’s order.

Durable Medical Equipment (DME)

What’s covered: Walkers, canes, wheelchairs, CPAP/O₂ equipment, bath safety items.
Where: Nationwide via Medicaid and ACA plans (approved vendors only).
How to qualify: Provider order + medical necessity; home assessment may be required.

Pro Tip: Ask vendors to fit equipment at home — many plans cover delivery and setup free.

Prescription Drugs

What’s covered: Formulary medications with $0–low copays; mail-order 90-day refills in most plans.
Where: All Medicaid and ACA plans (varying formularies).
How to qualify: Fill at in-network pharmacies; PA or step therapy for brands.

Pro Tip: If a drug is denied or too expensive, ask for a formulary alternative or file a quick coverage appeal.

Care Coordination

What’s covered: Nurse/social-worker case managers who coordinate care and resolve billing issues.
Where: Common in Medicaid managed-care plans and some ACA plans for high-risk seniors.
How to qualify: Request through your plan or PCP if you have multiple conditions or specialists.

Pro Tip: Identify yourself as a caregiver or multi-provider patient to fast-track assignment of a case manager.

How to Learn More

Visit Medicaid.gov’s official benefits list to see what your state covers.
You can also contact your local Area Agency on Aging via Eldercare.acl.gov for personal help applying or confirming eligibility.

Disclaimer: This article is for general educational purposes and may not reflect the latest state updates. Always confirm specific benefits and eligibility with your state’s Medicaid office or plan provider before making care decisions.