Medicaid Costs and Coverage

Medicaid coverage is an affordable health insurance option that is funded on the federal and state levels and intended mostly for low-income individuals and families. Understanding the types of Medicaid insurance available and knowing what services are covered by Medicaid can help potential applicants to make an informed decision about applying for health insurance benefits. The first step in answering the question “How much is Medicaid?” is to understand the Medicaid services available within a specific state. Several federal benefits for Medicaid are legally mandatory, but individual states may have their own additional state-funded Medicaid benefits to offer. Additionally, there are different types of Medicaid coverage available depending on eligibility requirements met. Medicaid cost estimates may depend on the specific Medicaid program in which an applicant qualifies to enroll. Certain programs may involve associated fees such as premiums, deductibles and copayments. Learn about mandatory Medicaid covered services, and answer the question “How much does Medicaid cost in the United States?” by reading the information below.

What services are covered by Medicaid at the federal level?

In conjunction with learning how much Medicaid costs in the United States, applicants should also understand the mandatory services covered by Medicaid in each state before applying for Medicaid. The following is a list of required services Medicaid covers in each state as required by federal law:

  • Inpatient hospital services
  • Early and Periodic Screening, Diagnostic and Treatment Services
  • Outpatient hospital services
  • Home health services
  • Nursing services
  • Physician services
  • Health clinic visits and services
  • Health centers that are federally qualified
  • Laboratory and X-ray services

To learn more about Medicaid covered services available throughout the U.S., you can download our comprehensive Medicaid guide today.

What does Medicaid not cover at the federal level?

Besides the federally mandated services covered by Medicaid in the United States, there are also many services that are optional for each state, usually at the state’s own discretion. These optional Medicaid services may also have specific fees attached, as they are not required by federal law. These fees for Medicaid coverage can include annual deductibles, premiums or copayments to cover the remaining balances for services not covered by Medicaid at the federal level. All applicants who are unsure about what services Medicaid does not cover in their state can contact their local Medicaid provider for more information. Here are a few of the services Medicaid is not required to cover in the United States and services that are optional on a state-by-state level:

  • Prescription drugs
  • Physical therapy services
  • Occupational therapy services
  • Speech, hearing and language services
  • Podiatry service
  • Chiropractic services
  • Optometry services
  • Eyeglasses
  • Prosthetics

The above list represents services that are not covered by Medicaid on a federal level. This can mean, however, that an applicant’s state can elect to cover these costs using state funding. Once an applicant is approved for Medicaid coverage, then he or she will learn in detail the types of Medicaid insurance he or she is eligible to receive. Individual states may feature a wide range of optional Medicaid covered services offered to approved applicants. However, some non-essential medical services, such as elective cosmetic surgery, are never covered by Medicaid. You can download our complimentary guide to learn more about optional Medicaid benefits today.

How much does Medicaid cost?

Most potential applicants initially wonder “How much is Medicaid and what costs will come out-of-pocket?” Medicaid cost estimates vary throughout the United States, as individual states will require different sets of fees for services. While Medicaid offers no- or low-cost health care benefits, some associated Medicaid costs, such as copayments, can vary depending on the beneficiary’s state and particular Medicaid program. Since Medicaid is a government-funded program, the costs for out-of-pocket fees are usually minimal. For instance, Medicaid coverage in most states includes a maximum copayment limit that helps to keep medical costs low for those who meet eligibility requirements for Medicaid.

In addition to income playing a factor in the cost of Medicaid, eligibility levels also factor in the costs for Medicaid coverage in the United States. For instance, pregnant women are covered for all pregnancy-related care, which includes medical services throughout the pregnancy all the way to treatment for complications that occur up to 60 days postpartum. Medicaid benefits coverage for children typically also includes more comprehensive medical benefits, including dental and vision services.