Whether you are new to Medicaid to have been using it for years, you may have questions regarding how it works. Medicaid is both a federal and state-funded program, but that doesn’t mean it works the same in every state.
In New York, Medicaid covers about 24% of the population which is one of the highest in the nation. With so many people on Medicaid, it’s important to understand how it works and what you can do with your issued health card.
(If you already have Medicaid you can qualify for the CDPAP program)
What is a Medicaid card?
Your Medicaid card is simply the way that you are identified. They are Common Benefit Identification Cards or CBIC. CBICs are given for several different government benefit programs including Medicaid.
If you already have a CBIC card for another program, you don’t have to get a new one for Medicaid. However, if it’s your first time using Medicaid or any assistance program, you will need to obtain a CBIC.
How do I get a Medicaid card?
The first step is applying for Medicaid and seeing if you qualify. It will depend on your income and household size. You can apply even if you aren’t sure if you qualify and will usually receive a response within 45 days.
If you do qualify, you will receive your CBIC in the mail at the address you used on your application. Remember that everyone in your family will need a separate Medicaid card. They are not used as family cards. Make sure everyone in your household and all your dependents is listed on your application so they will receive their own cards.
What are the benefits of having a Medicaid card?
The benefits of having Medicaid are numerous. It allows you to get affordable health care and access to services you otherwise might have a hard time paying for.
You can use your Medicaid card for:
● Regular exams
● Hospital stays
● Hospital services (in-patient and out-patient)
● Family planning services
● Transportation services to and from medical appointments
● Emergency room visits and emergency transportation costs
● Prescriptions
● Doctor and clinic visits
● Immunizations
● Medical supplies and equipment
● Lab tests
● X-rays
● Vision
● Dental
● Nursing home services
● Home health care and personal care
● Counseling, psychiatric care, and therapy
● Prenatal and postnatal care for pregnant women
This list is not exhaustive. There are several other places you can use your Medicaid card and more services available to you.
How do I get a new Medicaid card in NY?
If you have lost your card or think it may have been stolen, you will need to report it to the Department of Health and Human Services. Much like a credit card, Medicaid cards can have fraudulent activity that needs to be reported and watched closely.
If your children have Medicaid cards, you might want to consider keeping them for them to minimize the risk of them being lost or stolen.
Once you have reported the card stolen, you can call the New York State Department of Health’s Medicaid Help Hotline at 1-800-541-2831. There is also a number on the back of your Medicaid card that you can call if you are replacing a damaged card still in your possession.
There are several ways you can get a new Medicaid card in the event it was lost or stolen:
● Online at New York City’s official website. You will need your birth date and the CIN# or the Case#.
● By email
● By mailing in a replacement form
● By faxing in a replacement form
● By applying in person at the Medicaid office
● By calling 311 and talking to a representative
The representative on the phone will ask you some identifying questions such as your social security number, birth date, and address. They will also ask for your Medicaid ID number which may be hard to locate if you have lost the card. Consider keeping your ID number written down somewhere or have it saved on your computer.
The representative usually has ways to look up the ID number for you if you can’t locate it. If you are more comfortable getting a replacement card online, you can visit New York City’s official website and fill out the form. Make sure to fill out all the lines completely and ask that the new card be sent to your house.
If a phone or online option won’t work for you, you can always visit the Medicaid office closest to you. The people at the office will ask for your Medicaid number and Social Security number. You will get the card the same day you go into the office.
If the card is being sent in the mail, you will receive it within 7-30 days if your application was successful. Most people receive their new card within 10 days.
To fill out the Medicaid form for a replacement card make sure you fill it out correctly with:
● Your birthdate
● Your address
● Your Social Security Number
● Your Medicaid ID number
If you are trying to get a replacement card in person at the office, you will also need:
● Passport
● Driver’s license
● Other government-issued ID
Remember that all replacement forms can be found by logging into your Medicaid account. You can always print them from home and then mail or fax them into the office if you don’t feel like applying in person.
The easiest ways to get a replacement card are online or by calling.
How much does it cost to replace Medicaid cards?
A replacement Medicaid card should be free in the state of New York. If someone asks for money to replace the card, never give it to them.
Can I print a replacement Medicaid card?
In the state of New York, you cannot print a replacement card. In other states you can, so people may be confused to learn this if they have recently moved. It is not legal to print replacement cards from your home.
This is partly because Medicaid fraud is common in New York and the state government wants to ensure that cards are not being used for more than one person. To keep your card and yourself safe, make sure you are not giving your ID number out.
You can also follow these tips to avoid fraud:
● Never post your Medicaid number of information online
● Treat the medical card the same as your social security card and keep it in a safe place. Do not share the number with anyone.
● Never give the number to people who come to your home saying they need it for medical testing or exams.
The only people that should have your Medicaid number are yourself and your doctors. The only time you should show people your Medicaid card is when you are visiting a clinic or hospital.
Do I have to reapply for Medicaid every year?
Yes, each year you will need to reapply for Medicaid. The application is usually much easier the second time because it will save all of your basic information and you only need to update your income and a few other items.
If your income has changed, you may not be eligible anymore. They will send you an email or an alert to tell you if you will no longer be receiving Medicaid. You might also get a rejection letter in the mail.
If are still eligible, you will receive a new CBIC card in the mail within a few weeks of completing the renewal application. Make sure to keep your address updated so that your forms and new card are sent to the right place.
What does a Medicaid card look like?
All Medicaid cards have the same design. It is blue and gray with a yellow strip dividing the bottom and top sections. The Medicaid card is a CBIC card so it will look the same as cards for Temporary Assistance to Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP), and the Healthcare Exchange Program (HX).
The CBIC card should also have your information:
● Your signature
● Your photo
● The card number
● The access number
● Your Medicaid ID number
● Your name
● Your date of birth
If you notice that any of this information is wrong when you get it in the mail, contact the Medicaid office right away. Everything needs to be spelled out correctly for you to use the card. Check your children’s and spouse’s card as well.
When do you have to present your card?
There are several times and places where you will need to show your Medicaid card. This is why many people choose to keep it in their purses or wallet.
Make sure to present your Medicare card when:
● You go to a clinic for a checkup
● You need to go to the emergency room
● You are getting routine blood work completed
● You are receiving care for regular checkups
● You visit the hospital for any reason
● You are staying in a nursing care facility
● You need to buy medical supplies for a doctor-diagnosed condition
● You are visiting the eye doctor
● You are visiting the dentist
● You are getting x-rays
● You are filling or picking up a prescription
How does Medicaid work for vision and dental?
Some people are surprised when Medicaid covers expenses related to vision and dental because even some other insurance plans do not pay for teeth or eye-related doctor visits.
Medicaid pays for limited and routine services only. This means a condition that is life-threatening or could cause a disease.
Children have more options for dental care because of the Early Periodic Screening, Diagnosis, and Treatment Program (EPSDT). For example, Medicaid will pay additional services for children under 21 such as:
● Preventative care such as annual cleanings
● Emergency dental care
● Restorative care
● Emergency orthodontic care for children
Only medically necessary procedures will be covered for adults such as:
● Teeth extractions
● A procedure to prevent tooth or gum disease
For both children and adults, Medicaid does not cover implants, bridgework, dentures, or any cosmetic work.
For eye care, you only have limited access to services as well. For example, Medicaid will only pay for eye exams every two years. In most people, getting an eye check every two years is normal and you shouldn’t need any additional exams.
Medicaid will also pay for:
● Eyeglasses when necessary
● Contact lenses (needs prior approval)
● Surgical procedures
● Orthoptic training
All procedures need approval before being performed. The options for glasses and lenses might also be limited to certain kinds of colors.
Can I use my Medicaid card for prescriptions and over-the-counter drugs?
In New York, the prescriptions available to you through Medicaid are very comprehensive. Any Medicaid provider is expected to select the cheapest option when they prescribe you something from the New York Medicaid beneficiary.
If you see that a brand-name drug has been prescribed to you, ask the doctor to verify that it is the right one. You always want to make sure a prescription being filled is covered before you pick it up.
Generic brands are often prescribed and work just as well as the big brand names. For over-the-counter products, your doctor may be able to write a fiscal order for you that will reimburse you for the over-the-counter drug. This option is only available sometimes, so always ask your doctor if it is an option.