Medicaid Costs and Coverage in Michigan

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Medicaid coverage in Michigan has the intention of providing affordable health care options to low-income families and eligible applicants. The different types of Medicaid insurance available include more than one option to approved applicants seeking medical benefits. Most new applicants have concerns about what services are covered by Medicaid and how much does Medicaid cost Michigan enrollees. MI Medicaid coverages extend through a variety of health care services and treatments considered medically necessary. The program will not cover elective procedures and services from non-Medicaid providers. Knowing what does Medicaid not cover is important to avoid financial surprises after applying to the Medicaid program. With just a bit of understanding and knowledge involving Medicaid coverages, applicants can avoid unnecessary burdens on a financial or medical level. Medicaid benefit coverages include not only the medical services and treatments required by law on a federal level, but also the services that Michigan elects to cover as well. Since federal and state provisions fund Medicaid in Michigan, state officials can choose to cover certain Medicaid benefits at their discretion. To learn more about Medicaid cost estimates as well as the services Medicaid will cover in Michigan, continue reading the following sections.

What services are covered by Medicaid in Michigan?

One of the most critical components in understanding Medicaid coverage in Michigan involves learning what services are covered by Medicaid and what services are not. It is worth noting that simply because Medicaid covers medically necessary health care services does not mean that every component of the service will be covered. For instance, while pregnancy services or family planning is included, there may be time constraints to the services. Knowing what Medicaid will cover as well as the specifications to those services can save applicants time and headaches. Basic Medicaid services covered in Michigan can include but are not limited to:

  • Doctor’s office visits, hospitalizations and emergency services
  • Mental health and rehabilitation services
  • Preventive and wellness services
  • Laboratory services
  • Maternity and newborn care
  • Prescriptions drugs

Once an applicant is approved for Medicaid coverage, he or she will receive a list of benefits and options that will be applicable. Covered services for Medicaid can vary, so it is always worth exploring the exceptions to each service offered.

Learn more about the basic requirements the federal government requires Medicaid to provide enrollees by downloading our free guide.

What services are not covered by Medicaid in Michigan?

All applicants should learn the basic services covered by Medicaid in Michigan as well as the services that Medicaid will not cover. With varying types of Medicaid insurance in Michigan, especially when it comes to different Medicaid eligibility levels, knowing the services that will not be covered is imperative. A quick way to rule out if medical treatments not covered by Medicaid is by determining if the physician or doctor is an actual Medicaid provider. If not, then the services or treatments he or she offers will not be covered. In conjunction, if a medical service is not considered necessary or if it is an elected service, then it is likely not to be covered by Medicaid. A few services that Medicaid will not cover in Michigan include but are not limited to:

  • Experimental services and treatments
  • Elective abortive services
  • Cosmetic surgeries and services
  • Health services provided by relatives or friends
  • Acupuncture
  • Infertility treatments or services

Medicaid coverage can vary depending on the eligibility and qualifications of an approved applicant. It is also worth understanding that if a service is not covered by Medicaid, but is considered necessary by a professional, then approval for coverage can be requested. A doctor can submit prior authorization to see if Medicaid will cover the service at no cost or low cost to the applicant.

How much does Medicaid cost in Michigan?

There are a variety of costs for Medicaid coverages, which can include copayments, deductibles and premiums. Many applicants wonder how much is Medicaid and if the out-of-pocket expenses be high. In truth, it is hard to predict Medicaid cost estimates since there are many different moving parts in the program. However, the majority of costs are minimal since the program is designed for low-income applicants and patients with high medical costs. Copayments are a frequent cost for Medicaid services, but remain very low and affordable. Applicants should understand that if a copayment is necessary for Medicaid coverage and an applicant cannot pay, the doctor or provider can refuse service. In addition, copayments may be billed after a service is rendered, depending on the discretion of the provider.

The reason why costs and coverages for Medicaid can vary so much is due to the factors that contribute to eligibility. Different types of insurance for Medicaid offered can have exemptions for copayments or any other out-of-pocket expenses. For instance, Medicaid coverage that involves children generally has no added expenses or fees. Each state has its Medicaid coverage exemptions.Medicaid coverage based on income and assets for an applicant can influence his or her costs. The Medicaid program uses the federal poverty line as a way to measure eligibility. If an applicant falls well below the federal poverty line, then he or she may be exempt from incurring the bulk of out-of-pocket costs. Once an applicant officially becomes approved for Medicaid coverages, then he or she will receive further information about costs for Medicaid, exemptions and services covered that are tailored specifically to his or her eligibility.

For comprehensive information about Medicaid covered services and utilizing health care benefits, review our detailed guide.