Medicaid Costs and Coverage in Pennsylvania

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Medicaid coverage in Pennsylvania allows low-income individuals and families to receive aid that provides a variety of medical care. The types of Medicaid insurance provided by Medicaid (or Medical Assistance, as it is known in Pennsylvania) covers a broad range of medical services different categories of beneficiaries in the state. The basic guidelines for the program are established federally but managed locally by state officials. Additionally, Medicaid cost estimates and other parts of the program change from state to state. “How much is Medicaid?” is a common question from applicants who are curious about the program’s costs. Expenses such as copays may still apply to specific medical services for beneficiaries of the Medicaid program. Find answers to the question “How much does Medicaid cost in PA?” and learn about services that Medicaid covers by reading the sections below.

What services are covered by Medicaid in Pennsylvania?

The federal government outlines the Medicaid coverage guidelines, including the services that the program will provide. However, states may alter certain Medicaid covered services depending on regional needs and resources. The cooperation between officials and vital funding help create a system that is flexible, allowing each state to adjust and provide assistance to potential beneficiaries. The coverage benefits of Medicaid include a range of services that are mandatory across the nation and in Pennsylvania. For instance, Medicaid benefits in Pennsylvania provide coverage for inpatient and outpatient care. However, receiving Medicaid coverage does not always mean that there is no cost associated with the program. 

Medicaid coverage benefits are either mandatory and required by all states to implement or optional, which may or may not be adopted by the state. For instance, the Affordable Care Act (ACA) introduced an expansion of Medicaid to cover more individuals. Pennsylvania chose to extend Medicaid as outlined in the ACA, allowing for additional coverage to more residents. Often, what Medicaid covers in a state depends on local resources and needs, leading to the exclusion of certain types of coverage. Regardless of whether or not a service is mandatory or optional, there may be related costs. Some of the types of Medicaid covered services that are mandatory include:

  • Emergency room treatment.
  • X-rays.
  • Testing and treatment for specific diseases.
  • Inpatient and outpatient care.
  • Pediatricians.
  • Doctor visits.
  • Services from a primary care physician.

Pennsylvania Medicaid coverage extends to a broad range of potential beneficiaries. Both families and individuals benefit from the assistance. However, some groups receive certain other advantages as well. For instance, children receive extra aid under PA Medicaid coverage such as counseling as well as vision, hearing and dental screens. To learn more about the services covered by Medicaid, download our complimentary guide today.

What does Medicaid not cover in Pennsylvania?

Some medical services not covered by Medicaid are deemed unnecessary by the Medicaid program. Therefore, the program has some limits in its coverage. In some cases, Medicaid coverage will not help a potential beneficiary. Medicaid coverage in PA seeks to provide low-income applicants with medical aid, but it does exclude certain elective procedures and other non-critical services, including:

  • Cosmetic alteration procedures.
  • Occupational, speech or respiratory therapy.
  • Rentals from on-demand services while in a hospital room.
  • Hair transplants
  • Treatment of infertility.

Download our comprehensive guide to learn more about services that Medicaid does not cover.

How much does Medicaid cost in Pennsylvania?

Pennsylvania Medicaid cost estimates will be as low as possible to help low-income households. However, it is essential to understand that additional Medical Assistance costs may be required of beneficiaries. Before applying for PA Medicaid coverage, applicants benefit from knowing what expenses may be associated with Medicaid. For instance, families needing emergency services or requesting 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. In cases where copayments are due, Medicaid coverage caps the amount that a provider may charge. Limits set for Medicaid benefit costs are based on the size and income level of a family. State agents notify approved petitioners and provide detailed information such as the limits for costs. Providers are free to choose to charge the maximum amount but no more. Medicaid cost estimates in Pennsylvania and expenses associated with the program may change based on available resources and other factors.

In some situations, the answer to “How much does Medicaid cost?” is sometimes nothing at all. Some beneficiaries receive exemptions from ever paying copayments or other expenses related to services covered by Medicaid. Medicaid coverage recipients who are minors or living in nursing homes will typically not have to pay any out-of-pocket costs.