Medicaid Costs and Coverage in Georgia

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Georgia Medicaid coverage is available for low-income applicants who meet the eligible requirements for government health care coverage. Prospective petitioners should understand the types of Medicaid insurance options available in Georgia to find out what services are covered by Medicaid. Before applying to the Medicaid program, applicants should understand what does Medicaid not cover and cover in terms of services and treatments. The Medicaid insurance types and the services covered by Medicaid can differ depending on the eligibility levels of each applicant. Medicaid coverage will include the most basic medically necessary services and treatments to applicants who normally would not have the funds or means to receive them. While many potential petitioners assume all Medicaid coverage is free or without cost, there can be expenses associated with care. Medicaid coverages and different types of Medicaid insurance can hold a variety of fees including deductibles, copayments and premiums in some cases. Medicaid cost estimates can provide a better understanding of the fees to expect for services needed. To understand more about the types of Medicaid insurance available and how much does Medicaid cost in Georgia, continue reviewing the sections below.

What services are covered by Medicaid in Georgia?

The intention of Georgia Medicaid coverage is to provide medical services to keep applicants as healthy. The different types of Medicaid insurance and covered services can depend on the age of the applicant, the need for medical services and the income of the household. Certain petitioners will be eligible for Medicaid coverage on specific health care services, while other beneficiaries may not. For instance, children receive preventive dental care while adults do not typically.

However, while there may be variety in services covered by Medicaid and services Medicaid does not cover for many applicants, a few basic medical services will always be covered. Services that Medicaid covers in Georgia include but are not limited to:

  • Doctor and nurse office visits
  • Prescription drugs and prescribed medical equipment
  • Hospice, inpatient and outpatient hospital services
  • Emergency ambulance services
  • Non-emergency transportation to medical appointments
  • Hearing and vision care as well as immunizations for children

It is always important to check first to see if necessary Medicaid services are covered in order to avoid any unnecessary fees down the road. There may be limitations to coverage for Medicaid in many cases too. This can mean a limit on the number of times a specific treatment or procedure will be covered during a set period. Doctors may need to get permission from Medicaid in advance.

Learn more about the requirements of Medicaid to receive health care coverage in our complimentary guide.

What services are not covered by Medicaid in Georgia?

After understanding the varieties of services covered by Medicaid, it is important to understand the services Medicaid will not cover also. Sometimes, services not covered by Medicaid fully may be covered partially, with the remaining balance owed by the applicant out-of-pocket. Usually the services that are not covered by Medicaid are not considered medically necessary. Patients will have to find out how much is Medicaid cost for ineligible treatments and services. It is always best practice if an applicant is unsure whether a Medicaid service is covered or not to contact the Medicaid care provider. Some of the Medicaid services not covered in Georgia include but are not limited to:

  • Private hospital rooms, unless medically necessary
  • Private duty nursing
  • Cosmetic surgeries or services
  • Chiropractic services and experimental treatments
  • Medical providers who do not accept Medicaid
  • Medical services provided by relatives

Applicants should understand that the types of Medicaid insurance services not covered in Georgia may have exceptions. For instance, if a service is not covered by Medicaid but a petitioner’s doctor finds it medically necessary, then he or she has the ability to call on behalf of the patient and request Medicaid cover the costs. Determining how much Medicaid will cover will also depend on how much the beneficiary’s household earns and the Medicaid income limits for the household size.

How much does Medicaid cost in Georgia?

There are specific costs for Medicaid attached to the program that some applicants find to be unexpected, such as copayments. Depending on the GA Medicaid coverage for a particular applicant, he or she may need to pay small fees to receive medical care. While Medicaid usually pays most if not all of the bill for covered services, there may be a minimal copayment owed as well. It is worth understanding that a petitioner can deny medical service if an applicant cannot pay the copayment.

The differences in Georgia Medicaid coverages and costs can fluctuate depending on a variety of moving parts. For example, age can play an important role in determining Medicaid cost estimates. Children, for instance, have more complete Medicaid coverage across the board, along with senior citizens. Adults may find difficulties in having all of their Medicaid services covered.

In conjunction with age, income levels also play a factor in the types of Medicaid coverage offered and costs associated.Eligibility for Medicaid coverages in Georgia relies heavily on an applicant’s assets and income, which will eventually establish the type of Medicaid insurance he or she will qualify to receive. Applicants who have higher earnings within the eligible income bracket may need to pay premiums for medical services, while lower income applicants may have minimal copayments.

For details on special Medicaid groups eligible for additional covered services, download our comprehensive guide.