- $0 premiums and very low or no co-pays for services. - qualify if single person < $20K, family of two < $27K, kids covered if < $42K Summary of Medicaid vs Private Insurance: 1. Access: Only ~1/3 specialists accept Medicaid = longer waits 2. Medications: Limited to older/generic options 3. Authorizations: Need approval for many services that private insurance covers directly 4. Extra Work: Annual paperwork, self-coordinated care, slower processing (3-5 days vs 1-2) Bottom line: Same basic coverage but restricted options, more paperwork, longer waits. #### Prior Authorization Requirements | Service Type | Medicaid | Private Insurance | | ------------------------------ | --------------------- | -------------------------- | | Specialist Visits | Yes | No | | Hospital Stays (non-emergency) | Yes | Only extended stays | | Medical Equipment | Yes | Rarely | | Prescription Drugs | Most | Only specialty drugs | | Imaging (MRI/CT) | Yes | Only some advanced imaging | | Surgeries | Most | Only major ones | | Mental Health | Beyond initial visits | Rarely |