Medicaid Costs and Coverage in Montana

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Medicaid coverage in Montana allows low-income residents to receive necessary medical care. The types of Medicaid insurance provided by Montana Medicaid and Healthy Montana Kids (HMK) cover a broad range of medical services for many state residents. The basic guidelines for the Medicaid program are established federally, but managed locally by state officials. Additionally, Medicaid cost estimates and coverage options change from state to state. Medicaid offers some mandatory services required by federal law, but they also allow states to cover optional services. “How much is Medicaid?” is a common question asked by new applicants to the program. Expenses such as copays and deductibles may still apply to specific medical services for beneficiaries of the Medicaid program. Get answers to the question “How much does Medicaid cost in MT?” and learn about Medicaid covered services by reading through the sections below.

What services are covered by Medicaid in Montana?

The various services covered by Medicaid in Montana fall under the management of the Department of Public Health and Human Services (DPHHS). The coordination of Medicaid coverage funds on the state and federal levels allows the DPHHS to manage the system in the best interest of state residents. Additionally, the flexibility of Medicaid covered service options for states means that certain guidelines are mandatory, while others are optional. For instance, the Affordable Care Act Medicaid expansion allowed states to expand Medicaid to a broad group of residents. Montana chose to accept the expansion and now receives additional funds to cover more beneficiaries. Currently, the types of Medicaid services in MT that are mandatory according to federal law include, but are not limited to:

  • Home health care services.
  • Family planning.
  • Labs and X-rays.
  • Medical equipment.
  • Inpatient and outpatient hospital care.
  • Transportation

Medicaid coverage in MT also includes a number of optional services that Montana has elected to cover. These include, but are not limited to:

  • Podiatry
  • Optometry and eyeglasses.
  • Comprehensive mental health care.
  • Speech language pathology.
  • Physical and occupational therapies.
  • Ambulance services.

You can download our comprehensive guide to learn about additional services covered by Medicaid.

What does Medicaid not cover in Montana?

Limited resources mean that Montana Medicaid coverage does not cover every resident or every medical expense or procedure. For instance, services not covered by Medicaid include those considered “elective.” Medicaid does not cover these services, as they are not necessary to the beneficiary’s health. Services not covered by Medicaid in MT include, but are not limited to, elective procedures such as hair transplants, treatment of infertility or various cosmetic procedures. To learn more about Medicaid covered services and those that Medicaid does not cover, you can download our complimentary guide today.

How much does Medicaid cost in Montana?

Montana Medicaid cost estimates try to be as low as possible to help low-income petitioners receive vital aid. However, it is essential to understand that additional costs may be required of beneficiaries. Before applying for MT Medicaid coverage, applicants benefit from knowing what expenses may be associated with Medicaid. For instance, beneficiaries will have to pay $4 for pharmacy preferred brand drugs and $8 for pharmacy non-preferred brand drugs. However, generic drugs do not involve a copayment. Other services that are covered by Medicaid that do not need a copayment include, but are not limited to emergency room services, family planning services and some preventative services.

The cost of MT Medicaid for potential beneficiaries remains low because the program receives adequate funding. In cases where copayments are due, Medicaid coverage caps the amount that a provider may charge for services. Officials notify approved petitioners and provide detailed information such as the limits for costs. Medicaid cost estimates in Montana and expenses associated with the program may change based on available resources and other factors.

Additionally, certain Medicaid beneficiaries may be exempt from Medicaid costs as well, meaning they will not pay any out-of-pocket costs. These include members younger than 21 years of age, pregnant women and members receiving Medicaid services under the Medicaid breast/cervical cancer treatment program.