Medicaid Costs and Coverage in Illinois

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Most applicants wonder how much is Medicaid in Illinois for health care services. Since Medicaid coverage is geared specifically toward low-income applicants who meet the eligibility requirements, the Medicaid cost estimates remain fairly low. There are different types of Medicaid insurance available in Illinois depending on Medicaid eligibility and qualifications. It is important for all new applicants to understand that Medicaid coverage and costs can vary, and that certain fees such as deductibles, premiums and copayments can be attached to specific medical services and treatments. Knowing what services are covered by Medicaid and what does Medicaid not cover in Illinois is beneficial for enrollees. Medicaid must cover certain health care services according to federal mandates. However, the state may expand coverage to include additional claimants and medical services. Covered services influence how much does Medicaid cost enrollees, as treatments that are not completely covered may have nominals associated. To find out more about the types of Medicaid insurance available in Illinois, continue reading the information below.

What services are covered by Medicaid in Illinois?

Many applicants expect all types of Medicaid insurance in Illinois to cover the same services and treatments. However, the services covered by Medicaid in Illinois are affected by a variety of factors. Age, for instance, can be a huge factor, as children tend to have much more Medicaid coverage at no cost when compared to adults. All beneficiaries should understand the services covered by Medicaid and the services Medicaid does not cover based on their personal entitlement. For example, hearing aids are available to children with hearing problems but not to aging adults. Some of the basic Medicaid services covered in Illinois includes but is not limited to:

  • Hospital inpatient and outpatient care
  • Hospice and nursing home care
  • X-rays and laboratory services
  • Prescription drugs
  • Emergency dental services
  • Transportation for medical purposes

In addition, exceptions for the types of Medicaid services that are covered can be made if a doctor requests approval. Medicaid coverage in Illinois can span through a variety of services and treatments as determined by the state.

To learn more about the mandatory health care services available to Medicaid enrollees, download our comprehensive guide.

What services are not covered by Medicaid in Illinois?

Applicants should understand what does Medicaid not cover in Illinois so that they can see if Medicaid services will be enough to fit their needs. Financial surprises regarding Medicaid coverage are never a welcomed occurrence, especially during times of emergency. One of the easiest ways to determine if Medicaid covers a service is to find out if the doctor or specialist is an in-network provider, as Medicaid will not cover out-of-network medical professions. Services that are not covered by Medicaid may require extra fees. Medicaid enrollees will be responsible for covering these out-of-pocket Medicaid costs. Some services not covered by Medicaid include but are not limited to:

  • Experimental services and treatments
  • Cosmetic surgeries and services
  • Routine dental care for adults
  • Private nursing duties
  • Medical equipment that are not deemed necessary by a doctor

Claimants should also keep in mind that some health care treatments covered by Medicaid has limits. For example, Medicaid may only cover four prescriptions per month for each enrollee, unless prior approval is sought.

How much does Medicaid cost in Illinois?

Assessing the costs for Medicaid in Illinois can be done by calculating a variety of factors. Income requirements play a huge role in determining eligibility for types of Medicaid insurance as well as the Medicaid cost estimates for an applicant. Since Medicaid is for low-income residents, a majority of the costs are covered. For applicants to be eligible for complete Medicaid coverage, they must have collective household income less than a set percentage of the federal poverty line. However, there may be extra costs for Medicaid for enrollees with higher earners in the form of premiums, deductibles and copayments. After applying for Medicaid coverage, an approved applicant will be advised of the type of Medicaid insurance he or she will receive, along with the exact costs for copayments detailed per service. Regardless, the cost of copayments is still extremely low when compared to other forms of insurance available.

Out-of-pocket costs can be minimal when an applicant is covered for Medicaid. If Medicaid coverages do not extend to completely cover a full medical bill, then the applicant will be responsible to cover the remaining balance. However, oftentimes these out-of-pocket expenses cannot be detailed until a petitioner is in a circumstance where a specific procedure is needed. Medicaid cost estimates in Illinois can provide a general idea of the types of financial dues that an applicant will incur down the road. For an exact dollar amount, applicants can contact their local Medicaid provider or wait until they receive their information from Medicaid directly.

Download our free guide for comprehensive information about Medicaid benefits for approved claimants.