PrEP and Medicaid

by | Aug 28, 2020 | Paying for Prep

When beginning PrEP, many people have concerns about various things, such as side effects, costs, etc. Many Americans receive healthcare coverage federally. Medicaid and Medicare are the two most common options for federal healthcare. Luckily Medicaid covers ALL PrEP expenses and associated fees!

So, what is Medicaid?

Medicaid is a US federal and state program that assists with medical costs for people with limited income and resources. It provides health coverage to more than 72.5 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States.

Medicaid vs. Medicare 

You probably hear about the two a lot, and it’s easy to get them confused. Both offer health coverage, but Medicare is for 65 and older people and people of any age who have a disability. On the other hand, Medicaid is designed for anyone else who needs assistance with medical care costs. It’s pretty common for retired folk to use Medicare benefits. Some people use both Medicaid and Medicare when they need assistance for services that Medicare doesn’t fully cover. People who qualify for both programs are called “dual eligibles.”  

Who qualifies for Medicaid?

Some groups are automatically qualified to receive Medicaid benefits such as qualified pregnant women and children, low-income families, and individuals receiving Supplemental Social Security (SSI) benefits. However, there are exceptions for other individuals based on circumstances. And with the Affordable Care Act, Medicaid coverage was extended to cover nearly all low-income Americans under age 65 (for those over age 65, they qualify for Medicare!). As for income, candidates can be up to 138% of the Federal Poverty Level (FPL).

How do I know if I qualify?

You can find out if you qualify for Medicaid by visiting or calling the Ohio Medicaid Consumer Hotline at 800-324-8680. The Medicaid application typically has about 45 days to process applications.

The benefits of Medicaid

The benefits vary from state to state, but Medicaid in most states covers x-rays, doctor’s visits, hospitalizations, midwife services, family planning, etc. Some states also cover services like optometrist visits and eyeglasses, physical therapy, and dental. A benefit of Medicaid over Medicare is that it also covers long-term care, such as nursing facilities. And fun fact: Investopedia says Medicaid is the nation’s largest source of long-term care funding! A massive  perk of Medicaid, though, is that it covers prescription drug coverage for medications such as one of our favorites over here; PrEP.

I have Medicaid and want to begin PrEP

Great! Medicaid is an incredible resource because it covers all PrEP fees! The coverage includes most or all of the expenses of PrEP, medical appointments, and lab tests. Schedule an appointment with your healthcare provider, present the insurance information, and begin PrEP hassle-free.

Happy PrEPping!

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Have more PrEP questions?

This sweet, intelligent blogger is open to chat. Give her a call at (216) 286-7737 or fill out the form next to this blog.

Ask for help connecting to a doctor for PrEP.

Fiona Allan, University Hospitals
Call 216.286.7737
AKeem Rollins, MetroHealth
Call or Text 216.714.2223

Email AKeem at Metro for PrEP

Email Fiona at UH for PrEP