Medicaid Costs and Coverage in Idaho

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Idaho Medicaid coverage spans a variety of services in order to provide basic medical needs for low-income families. Applicants should understand what services are covered by Medicaid in ID and which services may have out-of-pocket fees. Idaho has different types of Medicaid insurance options available to petitioners that can vary in terms of services offered and fees associated. For example, while the government covers the majority of medically necessary services, there may be deductibles, premiums and copayments. Medicaid is a federal- and state-funded program, which means that government capital covers the majority of the costs for the Medicaid program. While difficult to predict certain Idaho Medicaid cost estimates, applicants can have a general idea of what to expect from the program before they submit an application. Knowing how much does Medicaid cost enrollees can help prospective petitioners budget for affordable health care. To learn more about the types of Medicaid insurance available, along with how Medicaid coverage can vary for eligible applicants, continue reviewing the information below.

What services are covered by Medicaid in Idaho?

Determining what services are covered by Medicaid in Idaho and what services are not is a main concern for potential applicants. ID Medicaid coverage expands to most fundamental medical necessities. In fact, there are federally mandated Medicaid services that all states must offer to their approved residents. In conjunction with these services covered by Medicaid, there are also optional services that Idaho chooses to honor as well. The basic Medicaid services covered in Idaho include but are not limited to:

  • Doctor visits and services
  • Laboratory tests and X-rays
  • Counseling and mental health services
  • Inpatient and outpatient hospital care
  • Smoking cessation

In addition to the above medical services, Medicaid will cover durable medical equipment, immunizations and prescription medication. Medicaid-eligible enrollees will have emergency ambulatory services cover, while select beneficiaries may qualify for non-emergency medical transportation. Additional Medicaid services can be covered on a case-by-case basis, depending on need of the applicant as well as what Medicaid medical professionals deems necessary.

Medicaid coverages for certain services and treatments can vary by the age or health status of the enrollee. For instance, children enrolled in Medicaid receive a more comprehensive list of covered services than adults do. Likewise, some treatments may have limits to the number of times Medicaid will cover costs in a certain time period. By means of example, claimants are restricted to six chiropractic services in a year. After applying for Medicaid, approved beneficiaries will select the type of Medicaid insurance that best serves their needs.

What services are not covered by Medicaid in Idaho?

Idaho applicants should learn what does Medicaid not cover in terms of services and treatments to avoid unnecessary financial surprises. This information influences how much Medicaid costs Idaho enrollees, as non-covered treatments will be the responsibility of the patient. Since there are different types of Medicaid insurance in ID, petitioners who meet the requirements for Medicaid should select the plan that meets their needs. Some of the Medicaid services not covered in Idaho include:

  • Cosmetic surgeries and services
  • Experimental treatments
  • Chiropractic services
  • Private nursing duties

Medicaid will only cover health care services considered medically necessary. Medicaid will also only cover services from an in-network provider. Even health care treatments and procedures normally covered will have out-of-pocket cost if rendered by a non-approved medical provider.

Find out more about which health care services must be covered by Medicaid in our comprehensive guide.

How much does Medicaid cost in Idaho?

Many applicants wonder how much does Medicaid cost in Idaho when they hear of premiums and copays. Medicaid coverage in Idaho is predominantly free of charge for many different services. However, applicants might be required to pay for Medicaid insurance coverage through premium payments and copayments. All applicants should know when approved for coverage what types of out-of-pocket expenses they can expect. Applicants attempting to learn how much is Medicaid in Idaho should also consider the fact that premiums may be involved. A premium can range from a specific dollar amount to a percentage of an applicant’s income. Premium amounts will be provided to applicants once they are approved. Copayment amounts for Medicaid coverage can also vary depending on a specific Medicaid eligibility criteria such as age, income and other important factors. For instance, if an applicant is considered a child, then a majority of his or her Medicaid coverages will be free of charge. Yet, many adults seeking the same treatments may have copayments. In many circumstances, if an applicant cannot pay the copayment the medical provider may refuse service.

In addition to age affecting the costs for Medicaid coverage, income too can be a factor. Primarily, an applicant’s income and assets compared to the federal poverty line determine Medicaid coverage in Idaho. This means that an applicant must be within a specific income bracket in order to be considered for Medicaid coverage. However, if he or she is on the higher side of the bracket, he or she may be required to pay more in terms of copayments or deductibles. Applicants seeking Medicaid coverage who have household earnings less than the federal poverty line may have more services covered by Medicaid and fewer required expenses, if any. Once an applicant is approved, the state will be notify him or her on the services Medicaid covers and the types of extra fees that may be necessary down the road.

Find out who is eligible for no cost Medicaid coverage by downloading our in-depth guide.