Medicaid Costs and Coverage in Oklahoma

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Oklahoma Medicaid coverage provides affordable medical care to low-income individuals and families. The types of Medicaid insurance offered by SoonerCare (Oklahoma Medicaid) cover a broad range of health care services. Medicaid benefits cover a lot of medical services but not all procedures. While officials attempt to keep Medicaid cost estimates low, in some cases there are costs to the recipient. Medicaid costs include such things as deductibles and copayments, which are out-of-pocket expenses for services that the program may not cover. Knowing what services are covered by Medicaid and how much it will cost is vital information for petitioners seeking assistance. Get details about how much is Medicaid in Oklahoma and what does Medicaid not cover by reading the outlined information below.

What services are covered by Medicaid in Oklahoma?

The federal government outlines the Oklahoma Medicaid coverage guidelines, including the services that the program must provide. States may add certain Medicaid benefits depending on regional needs and resources too. The cooperation between officials and vital funding help create a system that is flexible, allowing each state to adjust accordingly and assist potential beneficiaries accordingly. The flexibility of Medicaid coverage means that certain guidelines are mandatory while others are optional. For instance, the 2010 Affordable Care Act expansion allowed states to expand Medicaid to a broader group of residents. Oklahoma did not accept the expansion and therefore does not cover the additional citizens.

A combination of funds from the state and federal government allows officials to manage the system in the best interest of state residents. Services covered by Medicaid in Oklahoma are under the management of state officials who provide detailed information about Medicaid cost estimates for non-covered services. The benefits of Medicaid coverage in Oklahoma are numerous, especially for low-income families that cannot otherwise get affordable health care. The types of Medicaid benefits that are mandatory include:

  • Family planning and midwife services
  • Hospital, inpatient and outpatient services
  • Laboratory tests and X-rays
  • Nursing home services
  • Primary physician services
  • Testing and treatment for specific diseases
  • Transportation to medical centers

While Oklahoma provides coverage to a lot of eligible Medicaid recipients throughout the state, not all beneficiaries will receive all covered services. Some health services covered by Medicaid and limited to certain participants based on age or health status. For instance, children enrolled in Medicaid will have covered access to psychological counseling, chiropractic, vision, hearing and dental services. Adults will have to find out how much does Medicaid cost for these supplemental treatments and procedures, as there may be out-of-pocket expenses.

For comprehensive information on health care services that Medicaid must cover by law, download our free guide.

What services are not covered by Medicaid in Oklahoma?

Approved petitioners of Medicaid coverage in Oklahoma will need to know which services are covered after applying for Medicaid. Health services not covered by Medicaid can result in the participant being responsible for copayments or other expenses. One way to determine what does Medicaid not cover when it comes to health care services is to consider the provider. Even services normally covered by OK Medicaid will be denied if performed by an out-of-network medical professional. Likewise, Medicaid will not compensate procedures rendered by family and friends or homeopathic treatments. In most cases, the Medicaid program does not cover procedures or other medical services that are not considered medically necessary, otherwise known as “elective” procedures. Some services Medicaid does not cover include:

  • Cosmetic procedures
  • Adult hearing aid
  • Non-emergency dental services for adults
  • Occupational, speech or respiratory therapy
How much does Medicaid cost in Oklahoma?

Medicaid cost estimates in Oklahoma aim to be as affordable as possible since the design of the program is to help low-income potential beneficiaries. However, it is important to note that some beneficiaries may face additional costs. Before applying to receive Medicaid coverage, potential beneficiaries should be aware of such potential costs. For instance, households with earnings higher than the Medicaid income limits may have to pay out-of-pocket expenses. Additionally, certain recipients may be exempt from additional costs altogether.

Medicaid cost estimates are low because the program receives substantial funding. However, in cases where copayments are due, Medicaid coverage caps the maximum amount that a beneficiary may be charged. Applicants approved for Medicaid receive a notification from officials in the mail regarding possible costs, maximum limits and other vital details. Furthermore, health care providers involved with the Medicaid program may choose to charge less than the maximum limit, but it is up to the discretion of the provider. However, providers cannot charge any more for Oklahoma Medicaid coverage than the limits established by officials.

In some cases, the answer to, “How much does Medicaid cost?” is zero. Specific exemptions keep beneficiaries from paying copayments altogether. For example, recipients younger than 18 years of age, pregnant women or those living in nursing homes typically receive such exemptions. While many services require copayments, other do not. For instance, chemotherapy, emergency services, home health services and a range of aid provided to the elderly or the disabled do not incur copayments.

Find out how Medicaid costs for coverage can vary by recipient in our comprehensive guide.