Medicaid Costs and Coverage in Washington

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Medicaid coverage in Washington extends across the state to help low-income individuals or families get much-needed medical assistance. The types of Medicaid insurance provided by Medicaid cover a range of medical services for a lot of different state residents. Medicaid coverage, known as Apple Health in Washington, receives funds from the federal government, as well as the state government, to make the assistance possible. The rules and regulations for the program are established federally, but are managed locally by state officials. How much is Medicaid in Washington? Medicaid cost estimates and other parts of the program change from state to state. Medicaid benefits keep costs low, or remove expenses, altogether for eligible recipients. Out-of-pocket costs, such as copays, may still apply to specific medical services for beneficiaries of the Medicaid program. On the page below, applicants will find what services are covered by Medicaid in Washington and more about the costs associated with the government-backed healthcare program.

What services are covered by Medicaid in Washington?

The Health Care Authority (HCA) in Washington administers Medicaid coverage and oversees the federally established guidelines for the program, along with all the services included. States may alter certain Medicaid benefits, depending on local needs and resources. The cooperation between officials and essential funding helps create a system which allows each state to adjust accordingly and provide assistance in the best interest of eligible petitioners.

The coverage benefits of Medicaid include a range of services that are mandatory across the nation and in Washington. For instance, Medicaid benefits in Washington provide coverage for inpatient and outpatient care. However, Medicaid coverage does not always mean that there is no cost associated with the assistance. 

Medicaid coverage benefits are either mandatory and required by all states to implement, or are optional. For instance, the 2010 Affordable Care Act (ACA) introduced an expansion of Medicaid to cover more individuals. Washington chose to extend Medicaid as outlined in the ACA, allowing for additional coverage for more residents. Often, what Medicaid covers in a state depends on local resources and needs, leading to the exclusion of specific types of processes. Regardless of whether or not a service is mandatory or optional, there may be costs related to the process. Some of the types of Medicaid services that are mandatory to cover include:

  • Emergency room visits.
  • X-Rays.
  • Testing and treatment for specific diseases.
  • Inpatient and outpatient care.
  • Pediatrician visits.
  • Transportation to and from medical locations.
  • Dental care.
  • Services from a primary care physician.
  • Home health care services.
  • Doctor visits.

To review the full list of mandatory services, download our free guide.

Washington Medicaid coverage extends to a wide range of potential beneficiaries. Both families and individuals benefit from the assistance. Additionally, specific groups receive certain other benefits as well. For example, children receive extra aid for services such as:

  • Braces for teeth when needed for health reasons.
  • Private duty nurses in the home.
  • Vision, hearing and dental screenings.
  • Psychology and counseling.
  • Therapies, such as physical and speech aids.
What services are not covered by Medicaid in Washington?

The answer to, “What does Medicaid not cover in Washington?” means understanding the limitations of the program. In some cases, Medicaid coverage will not help a potential beneficiary. Medicaid coverage in Washington aims to provide low-income applicants with aid for health care, but does exclude certain services that are not life-threatening or are otherwise considered elective. The following services are not covered by WA Medicaid:

  • Procedures regarding cosmetic alterations
  • Occupational, speech or respiratory therapy
  • Rentals from on-demand services while in a hospital room
  • Hair transplants
  • Treatment of infertility
How much does Medicaid cost in Washington?

Medicaid cost estimates in WA try to remain as low as possible to help beneficiaries receive vital aid. However, it is essential to understand that additional costs may be required of beneficiaries. Before learning how to apply for Medicaid coverage, applicants benefit from knowing what expenses may be associated with Medicaid. For instance, patients that need emergency services or those who request preventative services may face some expenses. However, other Medicaid recipients 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 incurred by recipients. In cases where copayments are due, Medicaid coverage caps the amount a provider may charge for services. Established limits for Medicaid benefit costs are based on the income level and the size of a household. Officials alert approved petitioners and offer detailed information, such as the maximum potential costs. Petitioners should note that providers are free to charge the maximum amount, but not a penny more.

In some situations, the answer to “How much does Medicaid cost in Washington?” is sometimes nothing at all. Some eligible applicants get exemptions from ever paying copayments or other expenses related to Medicaid. The benefits of Medicaid are varied, and recipients who are minors, those who live in nursing homes, pregnant women or those suffering from disabilities typically do not have to pay any out-of-pocket costs. To learn more about the costs and coverage associated with Medicaid, download our free guide.