Applicants often wonder, “How much is Medicaid in Alabama?” and “What services are covered by Medicaid under these costs?” While the cost for AL Medicaid coverage varies, understanding the types of Medicaid insurance coverage available will help you to better understand the program. Additionally, it is important to understand what services are not covered Medicaid, as the state’s medical assistance program does not encompass every service. Beneficiaries will have to pay certain out-of-pocket costs, such as deductibles, copayments, coinsurance and more, in order to receive medical care in various instances. As such, understanding what is covered and what is not covered, as well as what must be paid when receiving government medical assistance, is crucial before applying for Medicaid enrollment. For more information on Medicaid cost estimates in Alabama and on the Medicaid covered services, review the sections provided below.
What services are covered by Medicaid in Alabama?
Services provided under Medicaid coverage in Alabama include mandatory benefits and the optional benefits provided by the state. Since Medicaid is funded by federal and state governments, there can be a bit of flexibility in determining what Medicaid covers and what it does not cover.
Mandatory Medicaid coverage benefits are those that all states are required to include. Optional benefits, meanwhile, are up to the discretion of the state and are decided on based on the funding available. It is important to note that mandatory medical assistance coverage benefits may still have copays or partial payments required, depending on the applicant’s eligibility level. A few types of Medicaid insurance mandatory benefits include but are not limited to:
- Hospital services, inpatient and outpatient.
- Nursing home services.
- Primary physician services.
- Testing and treatment for specific diseases.
- Home health care services.
- Health clinics.
- Family planning services.
- Midwife services.
- Transportation to medical centers.
To learn about additional mandatory benefits included in Medicaid, you can download our free guide.
What services are not covered by Medicaid in Alabama?
“What does Medicaid not cover in Alabama?” is another crucial question that many applicants ask. The services not covered by Medicaid are just as important to know as the mandatory benefits, so that petitioners do not expect to receive services that they are not eligible for under the medical assistance program. A few of the Medicaid services not covered in the state of Alabama include:
- Cosmetic procedures, such as cosmetic surgery.
- Hearing and dental services for beneficiaries 21 years of age or older.
- Occupational, speech or respiratory therapy for beneficiaries 21 years of age or older.
- Entertainment rentals in hospital rooms, like TV rentals.
- Any service or treatment for an individual who is not deemed eligible for Medicaid.
How much does Medicaid cost in Alabama?
While Medicaid cost estimates in AL tend to be extremely minimal (or even non-existent), they are still worth noting before applying for entry into the medical assistance program. For instance, out-of-pocket costs can be included for households that require emergency services or preventive services for children. Such out-of-pocket Medicaid costs are normally imposed on all Medicaid applicants, unless they have been exempt upon enrollment.
The reason why Medicaid price estimates are typically so low is because the program provides benefits to low-income and often sick individuals, primarily. Furthermore, if a copayment is required for covered Medicaid services in AL, said copayment will have an established maximum limit. This maximum limit is determined by examining the household income of the medical assistance applicant. After assessing the household’s income, the petitioner will receive a notification from the Medicaid office regarding his or her maximum copayment for services, and it is up to the discretion of the care provider whether or not to charge the maximum copayment. However, providers under coverage for Medicaid cannot charge any other amount, aside from the established copayment. In any case, it is important to note that copayment amounts have the potential to shift based on funding.
Additionally, some Alabama Medicaid coverage beneficiaries are exempt from paying copayments altogether, as mentioned before. Beneficiaries who are younger than 18 years of age, those residing in nursing homes, those who are pregnant and those who are Native American Indians with active user letters from Indian Health Services all do not have to pay Medicaid copayments in order to receive medical assistance coverage. Furthermore, various Medicaid coverage services do not require copayments in and of themselves, such as chemotherapy, birth control services, emergencies, home health services, various services for the elderly and the disabled (intellectually or physically) and more.