Medicaid Costs and Coverage in Hawaii

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Medicaid coverage in Hawaii is intended to provide affordable health care options for eligible low-income applicants. Prospective applicants should understand what services are covered by Medicaid in order to be prepared for issues that may arise. There are different types of Medicaid insurance available in Hawaii, which can be determined through eligibility levels once an application is approved. “How much is Medicaid?” is another common question. Since Medicaid is a federally- and state-funded program, the majority of the costs for particular services and treatments will be covered entirely by the state. However, Medicaid cost estimates for some related programs can include some costs to the enrollee. Most new applicants wonder, “How much does Medicaid cost in HI?” but since there are many factors that can influence costs exact numbers can vary. To find out what does Medicaid not cover as well as what is included in Medicaid coverage, continue reviewing the information below.

What services are covered by Medicaid in Hawaii?

Along with finding out how much is Medicaid in Hawaii, it is also equally as important to find out the services covered by Medicaid. The different types of Medicaid insurance available in Hawaii can cover different ranges of services. However, there are some basic services that are covered by Medicaid on a universal level for all approved applicants. Finding out the types of services covered by Medicaid can help prospective applicants or new enrollees to avoid unnecessary or unexpected fees. Limitations for Medicaid coverage can also arise, wherein a doctor will need to contact Medicaid to obtain permission for services and treatments. The basic medical services that Medicaid covers in HI include but are not limited to:

  • Emergency services.
  • Family planning services.
  • Pregnancy-related services.
  • Prescription drugs.
  • Inpatient and outpatient services.
  • Nursing facility.

If an applicant is under 21 years of age and eligible for Medicaid coverage in HI, then he or she is able to receive free medical and dental exams, immunizations and tuberculosis tests, hearing tests, as well as developmental screening services. To learn more about services covered by Medicaid, you can download our complimentary guide today.

What does Medicaid not cover in Hawaii?

After learning what services are covered by Medicaid in Hawaii, it is also important to understand what services Medicaid does not cover in Hawaii. Some forms of Medicaid coverage will either not pay for a particular service or only cover the service partially. If the service is partially covered, then the petitioner may be responsible for covering the rest of the cost out-of-pocket. It is recommended that for any service an applicant is unsure about, he or she contact the Medicaid care provider first. The majority of services not covered by Medicaid are considered medically unnecessary. Medicaid services not covered in HI include, but are not limited to:

  • Cosmetic surgeries and services.
  • Experimental treatments.
  • Medical supplies not deemed medically necessary.
  • Medical providers who do not accept Medicaid.

To learn more about services that are not covered by Medicaid, you can download our comprehensive guide today.

How much does Medicaid cost in Hawaii?

The majority of Medicaid coverage plans in Hawaii are free of charge. The Medicaid cost estimates can vary depending on a few different factors. If a beneficiary is younger than 21 years of age, then he or she is considered a child and will have a majority of costs covered by Medicaid. Some costs are associated with certain types of Medicaid coverage, such as Medicaid Fee-For-Service and Medicaid long-term care. Any required copayments through Medicaid are generally kept to a low minimum. The way a copayment works is that while HI Medicaid insurance pays the majority of a bill, a minimal copayment will be necessary on behalf of the applicant.

In addition to age playing a factor in Medicaid cost estimates, income levels too can influence the costs for Medicaid. Since Medicaid coverage in Hawaii is primarily based on the income requirements each applicant must meet, there may be different types of Medicaid insurance available based on these qualifications. This may mean that candidates applying for Medicaid benefits who fall closer to the federal poverty level may have a majority of their Medicaid services covered. Applicants with higher incomes seeking HI Medicaid coverage may have higher annual deductibles to be met, or higher copayments necessary.