Louisiana Medicaid coverage assists low-income families and applicants with affordable health care options they normally would not be privy to. Many applicants wonder what services are covered by Medicaid and the costs associated to treatments and procedures not fully covered. Knowing how much is Medicaid for approved applicants in terms of premiums, copays and deductibles can help prepare for medical expenses. Since the federal and state funded Medicaid program is for low-income households, the Medicaid cost estimates remain extremely low, if any at all. There are different types of Medicaid insurance options available, which can be influenced by a variety of factors including age of the applicant, income requirements and medical services needed. To find out more regarding the covered services by Medicaid and how much does Medicaid cost enrollees for health care services, continue reviewing the sections below.
What services are covered by Medicaid in Louisiana?
An important piece of understanding Medicaid coverage in Louisiana, involves learning what services Medicaid covers. Not only does Medicaid coverage include the federally required medical services and treatments, but also optional services selected by the state. Although the federal government funds a portion of the program, Louisiana has the discretion to choose additional health care services covered by Medicaid in the state. Understanding the types of Medicaid insurance options and services available can be extremely helpful to prospective applicants who want to know if their medical necessities will be met. Some of the basic Medicaid services covered in the state of Louisiana include visits to in-network doctors, inpatient and outpatient services, laboratory tests and radiology services. Other covered services can include but are not limited to:
- Certain dental and chiropractic services for adults
- Emergency and non-emergency transportation
- Hearing aids for children and durable medical equipment
- Behavioral health services
- Home health and hospice services
For a full scope of services Medicaid will cover, download our comprehensive Medicaid guide for free.
What services are not covered by Medicaid in Louisiana?
Knowing what does Medicaid not cover is as important as being aware of the covered health care services. All enrollees should determine the services not covered by Medicaid in Louisiana so they can better prepare themselves for any financial surprises, as there are costs associated with Medicaid insurance for certain types of plans. The different types of Medicaid insurance options available can directly influence what services are covered by Medicaid.
A great place for to start is with the medical petitioner or doctor. If the doctor is not a Medicaid provider, then the services he or she provides will not be covered by Medicaid. Most of the services not covered by Medicaid are generally not considered medically necessary. Medicaid coverage is intended for medical services, equipment and treatments determine to be necessary medical procedures. If the service is elected by choice of the applicant, then it usually is not covered by Medicaid. More services that Medicaid does not cover in Louisiana include but are not limited to:
- Experimental services and treatments
- Cosmetic surgeries and services
- Health services provided by relatives or friends
- Services rendered by a midwife or nurse practitioner
- Hearing aids for adults and non-prescribed medical equipment
Medicaid coverage can have specific exceptions to the rule. It is important for Medicaid eligible patients to understand the fine print in terms of coverage for Medicaid so that they better prepare themselves for medical emergencies. Oftentimes, if there is a medical service not covered by Medicaid in Louisiana, a doctor can attempt to receive prior authorization if he or she finds the medical service necessary for an applicant.
How much does Medicaid cost in Louisiana?
Costs for Medicaid coverage in Louisiana can vary greatly, depending on different factors that are both in and out of an applicant’s control. LA Medicaid cost estimates are hard to establish, although the common known factor is that costs will always remain exceptionally low. Medicaid coverage is geared specifically toward low-income families that would not otherwise have access to insurance. One of the requirements for an applicant to be approved for Medicaid is that his or her income is less than a certain percentage of the federal poverty line. However, Medicaid coverage can differ depending on where the applicant falls on the line. For applicants who earn more or have less family members in the household, they may be required to pay more for premiums and copayments. Similarly, applicants who are well below the federal poverty line may have lower copayments. In addition to income affecting Medicaid costs, age also plays a role. There are specific exceptions for Medicaid coverage copayments that involve children 21 years of age and younger.
Many applicants wonder, “How much is Medicaid in Louisiana?” in order to be prepared down the road. Medicaid cost estimates can differ, which is why applicants will only know exact costs for coverage once they are approved into the program. The good news is, Medicaid coverages and costs remain low for all applicants approved. Copayments remain minimal while the primary cost of Medicaid is covered through government funding. Costs for Medicaid tend to be higher when Medicaid does not cover the services but, even then, out-of-pocket expenses are on the lower end.
Download our guide for details on the services covered by Medicaid.