Medicaid Costs and Coverage in North Carolina

LOOKING FOR ADDITIONAL INFORMATION?

“How much is Medicaid in North Carolina?” is a common question from applicants in the state. In addition to Medicaid cost estimates, prospective applicants are also interested in learning about the types of medical services that Medicaid covers. NC Medicaid coverage includes certain services that are considered mandatory benefits, while other medical services are never covered by Medicaid. Types of Medicaid insurance and the cost of Medicaid for beneficiaries will depend on factors such as the recipient’s income and assets. Get answers to the question “How Much does Medicaid cost?” and learn more about medical services covered under Medicaid by reading the information below.

 

What services are covered by Medicaid in North Carolina?

While every state’s Medicaid coverage plan is required to provide “mandatory” benefits, it is up to each individual state to determine what other services it would like to include in its Medicaid program. The North Carolina Medicaid coverage program covers mandatory benefits plus extra services, which the state has selected for its residents.

Examples of the mandatory services covered by Medicaid include:

  • Doctor appointments.
  • Prescriptions.
  • Outpatient specialized therapy.
  • Mental and behavioral health care.
  • Medicare premiums, copayments and deductibles.

To learn about other services covered under Medicaid, download our complimentary guide today.

What does Medicaid not cover in North Carolina?

While the North Carolina Medicaid coverage plan is quite extensive, some services are excluded from the program. Services not covered by Medicaid in NC include investigational or experimental drugs, prescription drugs for people covered with Medicare and services that are deemed unnecessary to a participant’s health.

How much is Medicaid in North Carolina?

North Carolina Medicaid coverage is cost-free or low-cost. Most of the services covered through Medicaid are without charge. The Medicaid cost estimates vary on a case-by-case basis. Petitioners may be wondering “How much does Medicaid cost in NC?”, but the cost of Medicaid depends on the coverage an individual receives, as well as the amount of income and resources an individual may have. Members may have to pay a co-payment for certain Medicaid services. The amount of Medicaid costs a beneficiary needs to pay for his or her co-payment is also determined on a case-by-case basis, but payment for services can range from $1 to $100 dollars. Petitioners can receive an estimate of Medicaid costs after applying for Medicaid online. Typically, North Carolina Medicaid participants pay under $30 dollars for their copayment. However, all Medicaid beneficiaries have services available to them that do not require a co-payment, like check-up visits to the doctor, hospice services, hospital emergency department services, hospital inpatient services and more.

Meeting the Medicaid Deductible in North Carolina

Not every applicant for Medicaid coverage in North Carolina will be able to receive completely cost-free coverage. Different types of Medicaid insurance in NC will have different cost requirements. The NC General Assembly is solely responsible for establishing the income limits that are used to determine a candidate’s Medicaid eligibility. If the income of a family is more than the amount set by the General Assembly, applicants will need to pay a deductible before receiving Medicaid benefits. Just as caseworkers must determine Medicaid cost estimates for every applicant, beneficiaries who are required to pay deductibles will have their deductible determined by their caseworker as well. Participants will be accepted for Medicaid on the date that their medical costs equal the same amount as their deductible.

It is crucial for participants trying to meet their deductible for Medicaid coverage in North Carolina to keep their receipts in a safe place, as these receipts can be used to meet the deductible. All unpaid medical bills and current medical expenses can count toward meeting the deductible. In order to use past medical expenses to meet the deductible, petitioners must adhere to the following:

  • The bill must be less than two years old.
  • If the bill is more than two years old, the applicant must have made a payment on it within the past two years.
  • All medical insurance the petitioner had at the time must have been filed and either paid or denied.
  • If the applicant borrowed money to pay a medical bill, he or she must let his or her caseworker know so they can determine if the bill can be used towards the deductible.
  • The bill is completely unpaid but the medical provider is still sending bills.

To receive Medicaid benefits in North Carolina, candidates can submit expenses such as hospital charges, prescription drug costs, medical supplies, laboratory charges and more.