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Learn About Medicaid Costs and Coverage in Ohio

“How much is Medicaid in Ohio?” is a typical question asked by Medicaid applicants before they apply for benefits. Although the cost for Medicaid coverage varies by household, applicants have a better understanding of the program once they become familiar with the types of Medicaid insurance available to them. Furthermore, applicants must understand what services are covered by Medicaid in order to maximize their benefits. Although services covered by Medicaid in OH are many, including preventative care services, beneficiaries will still have to pay a few out-of-pockets costs such as copayments, deductibles and more. Therefore, interested petitioners must understand what health care services are covered through Medicaid, what health care services are not covered and the associated costs before applying for Medicaid assistance. For more information on Medicaid cost estimates and covered services in Ohio, continue reading the sections below.

What services are covered by Medicaid in Ohio?

Medicaid coverage in Ohio is extensive because the state has implemented numerous health care programs under Medicaid, including the Ohio Managed Care Plan. The Medicaid Managed Care Program is one of the types of Medicaid insurance in OH that offers its participants primary and preventative care services under a selection of doctors and hospitals associated with Medicaid. Like other Medicaid programs, the Ohio Managed Care Plan includes Medicaid coverage mandated by the federal government and optional coverage selected by the state government.

Additional costs for Medicaid beneficiaries may still apply regardless of whether or not a Medicaid service is mandated or optional. Mandatory services provided by Medicaid in Ohio include, but are not limited to:

  • Inpatient and outpatient services.
  • Family planning services.
  • Lab work and X-ray services.
  • Home health care services.
  • Physician services.

While the mandatory Medicaid insurance services are consistent throughout the entire United States, Ohio has elected to provide some federally permissible Medicaid services as well. Optional Medicaid services Ohio provides include:

  • Prescriptions.
  • Physical and occupational therapy.
  • Mental health care.
  • Addiction care.
  • Vision services
  • Dental services.

Ohio Medicaid cost estimates for these health care services may be limited to a specific dollar amount or number of visits per year. Additionally, Medicaid coverage may limit specialized services because of the setting in which they are provided. While the Managed Care Plan covers many services, some Medicaid services covered in OH are offered through special programs developed by the state. To learn more about services covered by Medicaid, you can download our free guide.

What services are not covered by Medicaid in Ohio?

“What does Medicaid not cover in Ohio?” is another important question many Medicaid applicants ask. It is essential for interested applicants to know what services are not provided through Medicaid so they do not expect to receive certain services that are not funded under the program. Services not provided under Medicaid in OH include the following:

  • Cosmetic procedures, including cosmetic dental procedures such as veneers.
  • Respiratory care services.
  • Prosthetics.

Since Medicaid coverage may not cover all forms of treatments, a potential Medicaid recipient in need of specialized care should first contact the Medicaid hotline to see if treatment is covered through the Ohio Medicaid program.

How much does Medicaid cost in Ohio?

Although Medicaid cost estimates in Ohio are quite low, they are still worth taking note of before petitioners begin their Medicaid application process. Certain types of Medicaid programs require copays and deductibles that are inclusive of out-of-pocket costs for specific Medicaid-provided health care services. For example, some dental care, such as root canals, require a small copay, whereas braces do not require a copay at all. These out-of-pocket Medicaid costs are generally imposed on all Medicaid recipients unless they have been exempt.

Typically, Ohio Medicaid cost estimates are low because of the nature of the program. The program is designed to primarily benefit low-income individuals who are oftentimes in need of medical care before even being accepted into the program. Additionally, covered Medicaid services in OH that require a copayment will have a maximum limit imposed on the payment in order to protect Medicaid recipients from paying more than they are able. However, the maximum Medicaid copayment limit varies, as it is determined through assessing an applicant’s household income. Once a petitioner’s household has met eligibility requirements and its income has been examined, the petitioner will be notified or his or her maximum copayment for Medicaid services. Health care providers affiliated with Medicaid can decide whether or not to charge a copayment or charge a copayment below the maximum limit. Furthermore, Medicaid applicants and beneficiaries alike should be aware that copayment amounts can fluctuate based on funding.

Beneficiaries of Medicaid coverage in Ohio who are exempt from paying copayments include pregnant women, individuals younger than 21 years of age and individuals who reside in a nursing home or another qualifying facility. In addition, certain Medicaid services in OH do not require a copayment at all. These services include family planning services, mental health care, drug and alcohol addiction care and inpatient and outpatient services.