Medicaid Costs and Coverage in New Jersey

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Medicaid coverage in New Jersey makes it possible for eligible individuals or families to get health care at low or no cost. The types of Medicaid insurance and coverage available to potential beneficiaries extend across a range of services. The funding for Medicaid coverage comes from both the federal and the state governments. In New Jersey, the Department of Human Services (DHS) manages the program on a state level, which includes reviewing applications and providing information to residents and applicants. New Jersey Medicaid benefits cover various medical services, but also exclude coverage for other types of services. Also, while officials attempt to keep Medicaid cost estimates low, in some cases, there are costs to the recipient in the form of copayments or other such charges. Medicaid costs include such things as deductibles and copayments, which are out-of-pocket expenses that programs may sometimes not cover. Knowing what Medicaid covers and the potential costs are vital for applicants seeking assistance. Discover details about Medicaid cost estimates in New Jersey and what services are covered by Medicaid in the below sections.

What services are covered by Medicaid in New Jersey?

The federal government outlines the Medicaid coverage guidelines, including the services that the program provides. States may alter certain Medicaid benefits, depending on local needs and resources, too. The cooperation between officials and vital funding helps create a system which is flexible, allowing each state to adjust accordingly and to provide assistance to potential beneficiaries.

The coverage benefits of Medicaid include a range of services that are mandatory across the nation and in New Jersey. For instance, Medicaid benefits in New Jersey provide coverage for inpatient and outpatient care. However, Medicaid coverage does not always mean that there is no cost associated with the assistance.

Medicaid coverage benefits are either mandatory, and are required by all states to implement, or are optional, which may or may not be adopted by the state. For instance, the 2010 Affordable Care Act (ACA) introduced an expansion of Medicaid to cover more individuals. New Jersey officials chose to extend Medicaid as outlined in the ACA, allowing for additional coverage for more residents. Often, what Medicaid covers is based on the needs of the patients and the resources available, which leads to some exclusion. Regardless of whether or not a service is mandatory or optional, there may be costs related to the process. Some of the types of Medicaid insurance that are mandatory include:

  • Emergency room visits.
  • X-Rays.
  • Testing and treatment for specific diseases.
  • Inpatient and outpatient care.
  • Pediatricians.
  • Transportation to and from medical centers.
  • Dental care.
  • Services from primary care physicians.
  • Home health care services.
  • Doctor visits.

New Jersey Medicaid coverage extends to a broad range of potential beneficiaries. Both families and individuals benefit from the assistance. However, additional groups receive other benefits as well. For instance, children receive extra aid under Medicaid coverage such as:

  • Braces for teeth when needed for health reasons.
  • Private duty nurses in the home.
  • Vision, hearing and dental screens.
  • Psychology and counseling.
  • Therapies such as physical, occupational and speech aids.

For more information about the medical services covered by Medicaid for children, download our guide.

What does Medicaid not cover in New Jersey?

For those potential beneficiaries asking, “What does Medicaid not cover in New Jersey?” it is important to first understand the limitations of the program. In some cases, Medicaid coverage will not help a potential beneficiary. Medicaid coverage in New Jersey aims to provide low-income applicants with aid for health care, but does exclude certain services that are not life-threatening or are otherwise considered elective procedures. In NJ, Medicaid does not cover:

  • Procedures regarding cosmetic alterations.
  • Occupational, speech or respiratory therapy.
  • Rentals from on-demand services while in a hospital room.
  • Hair transplants
  • Treatment of infertility.
How much does Medicaid cost in New Jersey?

New Jersey Medicaid cost estimates are as low as possible to help applicants struggling with income. However, it is essential to understand that additional costs may be required of beneficiaries. Before applying for NJ Medicaid coverage, applicants benefit from knowing what expenses may be associated with Medicaid. For instance, family members that need emergency services or who need to request preventative services may face some out-of-pocket expenses. Furthermore, some Medicaid beneficiaries may be exempt from such extra costs.

Medicaid cost estimates for potential beneficiaries remain low, because the program receives adequate funding. However, there are circumstances in which Medicaid costs are required from recipients. For example, in cases where copayments are due, Medicaid coverage caps the amount a provider may charge for services. Limits set for Medicaid benefit costs are based on the size and income level of a family. Officials notify approved petitioners and provide detailed information, such as the limits for costs. Keep in mind that providers are free to choose to charge the maximum amount, but not a penny more. In addition, Medicaid cost estimates in New Jersey and expenses associated with the program may change based on available resources and other factors.

For some asking, “How much is Medicaid?” the answer is sometimes ‘zero.’ Select beneficiaries receive exemptions from ever paying copayments or other expenses associated with Medicaid. The benefits of Medicaid are numerous, and recipients who are minors, living in nursing homes, pregnant or suffering from disabilities may not have to pay any out-of-pocket costs. Furthermore, Medicaid extends across a wide variety of health care services and procedures. Some of this comes with an additional charge and some does not. However, it is important to note that Medicaid coverage extends to procedures such as chemotherapy and home health services, which do not incur copayments. Download our free guide to learn more about the costs and coverage associated with Medicaid.