Medicaid Costs and Coverage in Minnesota

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Medicaid coverage in Minnesota was established in order to provide low-income families with affordable health care options and benefits. With different types of Medicaid insurance benefits available, approved applicants are able to receive medically necessary services and treatments at low or no cost to them. While MN Medicaid coverage can have fees attached, such as copays, deductibles and premiums at times, the Medicaid cost estimates always remain extremely low. It is worth it for all applicants to understand specifics regarding how much is Medicaid in order to avoid any unnecessary financial surprises down the road. With a bit or preparation and further understanding, applicants can better assess what services are covered by Medicaid and which are not. There may be certain pieces of information that are crucial to know in order to get the most out of the Medicaid program. For example, understanding prior authorization and the fact that doctors can request Medicaid to cover certain services otherwise not covered by the program if a patient needs it can make huge difference. Medicaid coverage benefits expand not only to the federally mandated services that are required by law, but also to services that Minnesota elects to cover. Since Medicaid is funded at a federal and state level, Minnesota can choose which optional benefits it wishes to cover for residents. For more information about Medicaid services covered for applicants as well as the types of Medicaid insurance options available in Minnesota, continue reviewing the information below.

What services are covered by Medicaid in Minnesota?

All applicants should understand the Medicaid coverage options in Minnesota in order to prepare themselves in case certain situations should arise. The services Minnesota Medicaid covers are medically necessary for an applicant and exclude many optional or elected services and treatments. Residents who meet the requirements of Medicaid should understand that not all beneficiaries receive the same coverage. For instance, children enrolled in the program receive more comprehensive coverage than adult do. Medicaid services covered in Minnesota include but are not limited to:

  • Doctor’s office visits
  • Alcohol or drug treatment
  • Laboratory services
  • X-ray services
  • Chiropractic care

Enrollees must keep in mind that services are only covered by Medicaid if preformed by an in-network medical provider. After applying to Medicaid, approved petitioners will find out what services are available to them free of cost and which providers are in the program’s network. However, officials will extend Medicaid coverage to out-of-network providers and non-covered health care treatments with prior authorization.

Find out what health care services are covered by Medicaid by federal mandate in our free guide.

What services are not covered by Medicaid in Minnesota?

Knowing what does Medicaid not cover is just as important for Minnesota enrollees as being aware of covered treatments. An easy way to rule out medical services that are not covered by Medicaid is to determine if the doctor is physician is a Medicaid service provider. If he or she is not in the network, then the services he or she provides will not be covered. In addition, Medicaid does generally not cover services or treatments that are elected by an applicant. This includes the following list of services:

  • Experimental services and treatments
  • Cosmetic surgeries and services
  • Health services provided by relatives or friends
  • Acupuncture
  • Medical equipment not prescribed or necessary
  • Infertility treatments or services

Medicaid coverage can be tricky, which is why consulting with a Medicaid professional or service provider is important. As mentioned earlier, Medicaid eligibility play a part in which services are covered by the health care program. By means of example, children may qualify for hearing aids whereas adults may not. There may be circumstances where Medicaid generally does not cover a service but a physician still finds the service to be medically necessary. In these cases, there may be exceptions for coverage made as long as approval is obtained in advance.

How much does Medicaid cost in Minnesota?

Minnesota Medicaid coverage always remains very low cost for approved applicants. There are different types of Medicaid insurance that will carry low out-of-pocket fees. For instance, monthly copays or deductibles may be required for certain applicants to pay, depending on eligibility status. The applicants wondering how much is Medicaid can rest easy, as Medicaid coverage is intended to be affordable. Copayments are usually the most notable out-of-pocket fees for approved applicants. Medicaid coverage can still carry minimal copayments for certain services and treatments. A service may only be partially covered by Medicaid and there still may be a minimal copayment that the patient is responsible for.

Medicaid cost estimates can be hard to predict as every potential applicant and petitioning applicant carries different medical needs and requirements. Medicaid coverage in MN provides basic care for all approved applicants, but often can provide coverage at a cost for certain situations. Essentially, Medicaid coverage is a cost-sharing program, with the government paying a majority of the cost and the applicant being responsible for the remaining balance. Medicaid income limits are a determining factor for eligibility and out-of-pocket costs.

There are certain exemptions to Medicaid coverage copayment amounts. Depending on the eligibility of an applicant and the Medicaid insurance type he or she qualifies for, there may be no fees whatsoever. People exempt from Medicaid coverage copayment include American Indians and Native Alaskans who receive care from an American Indian heath provider, women who are pregnant, petitioners in hospice care, petitioners enrolled in the Breast and Cervical Cancer program and more.

Download our in-depth guide for details on how to enroll in Medicaid coverage successfully.