Medicaid Costs and Coverage in Kentucky

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Petitioners often wonder, “How much is Medicaid in Kentucky and how will I be affected?” With different types of Medicaid insurance available, Medicaid cost estimates can change and fluctuate based on a variety of moving parts. Understanding the different ways that Medicaid coverage costs can change is extremely helpful to both new and established applicants. In addition to Medicaid costs for coverage, there is also an importance in learning what services are covered by Medicaid and what does Medicaid not cover. Since Medicaid is a government-run program, the majority of the costs are covered on a federal and a state level. This means that most coverage for Medicaid services is free-of-charge for the applicant. However, if there are any fees associated—deductibles, copayments or premiums—they will be minimal, at best. All applicants should still understand the types of Medicaid insurance options available, along with addressing, “How much does Medicaid cost in Kentucky?” Each state differs in terms of the Medicaid benefit coverages available, so Kentucky applicants should discover the options available to them, specifically. To learn more about Kentucky Medicaid coverages, along with the services covered by Medicaid, continue reading the sections provided below.

What services are covered by Medicaid in Kentucky?

Each state, including Kentucky, has services covered by Medicaid that are federally required. There are also Medicaid coverages in Kentucky that are elected as optional for state coverage. Since the coverage of Medicaid is funded on both state and federal levels, there is flexibility in what Kentucky officials elect to cover, and what services are not covered by Medicaid. The federal Medicaid coverage benefits may still have fees attached to the services, such as copayments and premiums, regardless of if they are required by law. In addition, eligibility levels for Medicaid coverages can still affect if any payments are due. It is important for all applicants to understand the services covered by Medicaid in Kentucky in order to be prepared for any circumstances that should arise. Medicaid-covered services include, but are not limited to the following:

  • Doctor’s office visits
  • Inpatient services
  • Outpatient services
  • Emergency room services
  • Emergency transportation services
  • Physician services
  • Radiation therapy
  • Chemotherapy
  • Family planning
  • Maternity services
  • Prescription drugs
  • Laboratory services

To review a more comprehensive list of what is covered by Medicaid, download our free guide.

When an applicant is curious if a specific medical treatment or service is covered by Medicaid, then he or she can contact a local Medicaid provider or a doctor for more information or prior authorization.

What services are not covered by Medicaid in Kentucky?

Medicaid services in Kentucky that are not covered are also an important part of understanding the program. With the different types of Medicaid insurance options available, services can vary in terms of what is covered and what is not covered by Medicaid. The majority of treatments not covered by Medicaid in Kentucky include anything that is deemed medically unnecessary. Another simple way to determine if a medical service is covered by Medicaid is to see if the doctor is a Medicaid provider. If not, then generally, any services provided will not be covered by Medicaid. Other services that Medicaid will not cover in Kentucky can include, but are not limited to the following:

  • Cosmetic surgeries and services
  • Experimental services and treatments
  • Transplants
  • Health services provided by relatives or friends
  • Home health services
  • Speech therapy services
  • Nursing facility services

It is worth understanding that while there are services not covered by Medicaid in Kentucky, there are exceptions to the rule. For instance, simply because a treatment is not covered by Medicaid does not mean that it will not be covered, if medically necessary. Some medical services need to be authorized prior to scheduling. An applicant’s primary care provider can request approval for these services to be covered by Medicaid before they can occur. Simply because prior authorization is requested, however, does not mean that the services are guaranteed.

How much does Medicaid cost in Kentucky?

Medicaid coverages and costs in Kentucky are extremely minimal, sometimes with no charges at all. While it is difficult to provide estimated Medicaid costs, when learning how to apply for Medicaid, applicants should understand the types of financial obligations that may occur. All Medicaid beneficiaries are required to pay any determined copayments; however, there are certain individuals that are exempt from paying any copayment amounts. For example, children who are 18 years of age or younger are exempt from paying any copayments for Medicaid coverage, but this same rule may not apply to CHIP recipients in KY. In addition, Medicaid coverage copayments are not required from pregnant women, institutionalized applicants and American Indians.

Applicants who wish to learn, “How much is Medicaid?” should know that exact answers will only be provided when they are accepted into the program. However, it is worth noting that costs for Medicaid coverage can change greatly, depending on a variety of factors. Age, for example, can be a determining factor that can influence how much an applicant must pay for a copayment, or if there is any payment at all. The majority of adults approved for Medicaid coverage most likely incur the bulk of the copayment costs. Yet, another reason that costs for Medicaid can be different has to do with income requirements. Applicants who fall well below the federal poverty line may have less premiums, deductibles and copayments than those who earn higher incomes.