Medicaid Costs and Coverage in Vermont

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Vermont Medicaid coverage creates a path for citizens struggling with income to receive assistance that takes care of a variety of medical services. The types of Medicaid insurance provided by the program cover a broad range of treatments and procedures for many state residents. Medicaid coverage receives billions in funds from the national government, as well as the state government. The structure for the program is established federally, but is managed locally by state agents. Medicaid benefits are well-funded by officials who work to keep costs low or to remove expenses, altogether for recipients. However, expenses such as copays may still apply to specific medical services for beneficiaries of the program. What services are covered by Medicaid in Vermont? Learn the answer, along with what Medicaid does not cover, by reviewing the sections below.

What services are covered by Medicaid in Vermont?

Medicaid coverage guidelines, including the services that the program provides, are designed by the federal government. However, states may alter certain Medicaid benefits, depending on local requirements, which essentially allows for flexibility. The coordination between state and federal officials and the funding which supports the system grants states the ability to adjust Medicaid coverage in VT based on what resources are available.

The benefits of Medicaid in VT provide a range of medical services that are mandatory across the nation and in the state. However, Medicaid coverage benefits can be mandatory and required by all states to implement, or are optional to adopt. For instance, the 2010 Affordable Care Act (ACA) introduced an expansion of Medicaid to cover more adult individuals who could not otherwise get medical care. Vermont chose to extend Medicaid as outlined in the ACA, allowing for coverage of low-income adults. Often, what Medicaid covers extends beyond what is outlined depending on local resources and needs, which leads to the exclusion of certain types of coverage. Some of the types of Medicaid insurance-covered services that are mandatory include:

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

Medicaid coverage in Vermont extends to many possible recipients. Individuals and families benefit from the assistance. Additional groups receive certain other advantages as well. For example, children receive extra aid under Medicaid coverage known as Dr. Dynasaur, which includes services such as:

  • Braces.
  • Home health care visits.
  • Vision, hearing and dental checks.
  • Psychological services.

To learn more about children’s healthcare benefits, download our free guide.

What services are not covered by Medicaid in Vermont?

For potential beneficiaries seeking Medicaid coverage, it is also important to learn the answer to, “What does Medicaid not cover in VT?” as the program excludes certain types of medical procedures. Knowing the procedures and services not covered by Medicaid means that applicants will not spend time trying to gain aid that is otherwise unavailable. In most cases, medical services which are not considered medically necessary, otherwise known as “elective” procedures, are not covered by the program. Some of those services include:

  • Hearing and dental services for petitioners.
  • Occupational, speech or respiratory therapies.
  • Cosmetic procedures.
How much does Medicaid cost in Vermont?

Medicaid cost estimates in Vermont are kept low, since the purpose of the program is to help residents who struggle with earning enough money to afford coverage. Also, it is important to note that, in some cases, Medicaid-eligible applicants may face additional costs. Before receiving Medicaid coverage, petitioners should be aware of such potential costs. For instance, beneficiaries that require certain services such as preventative care may have to pay out-of-pocket expenses.

Medicaid cost estimates are low, because the program receives substantial funding. But, in cases where copayments are due, coverage for Medicaid limits the total amount a medical provider may charge. Eligible applicants for assistance will get a notification from state agents in the mail regarding potential expenses, payment limits and other essential information. Furthermore, providers involved with the Medicaid program may choose to charge less than the maximum, but it is at their discretion. Medicaid providers cannot charge any more for VT Medicaid coverage than the limits set by the program.

In some cases, the answer to “How much is Medicaid in Vermont?” is zero dollars. Some exemptions keep applicants from using any of their own money. For example, costs for Medicaid benefits for applicants who are minors, pregnant women, living in nursing homes, blind or otherwise disabled can typically receive greater financial relief from the program. Potential beneficiaries should be aware that Medicaid coverage in VT extends across many procedures which are provided at a low cost. To learn more about Medicaid costs and coverage, download our complimentary guide.