Cost and Coverage of Medicaid in Florida

How much does Medicaid cost in Florida? The Medicaid cost estimates in Florida vary, depending on the type of patient eligibility group the applicant belongs to and his or her household income. Medicaid coverage is not a uniform health program. Instead, the types of Medicaid insurance differ from state to state, as each state’s own health department has the power to estimate Medicaid costs, as well as to decide what services are covered by Medicaid.

To review more information on what is and is not covered by Medicaid, review the following sections:

  • Medicaid services covered in Florida

  • What does Medicaid not cover in Florida?

  • Types of Medicaid insurance for an additional cost in Florida

Medicaid Services Covered in Florida

What services are covered by Medicaid in Florida? If a candidate is eligible for Medicaid coverage in FL, he or she will receive an enrollment packet in the mail following acceptance into the government-sponsored medical assistance program. Since Florida Medicaid coverage differs in comparison to other state medical programs, petitioners may find that what is covered by Medicaid in one state may be considered what is not covered by Medicaid in another. Some of the services covered by Medicaid in FL include:

  • Birthing services and family planning

  • Behavioral health services

  • Hospital services (inpatient, outpatient and state mental health)

  • Dental, vision, hearing, chiropractic and podiatric services

  • Radiology and nuclear medicine

  • Drug services

  • Surgeries and transplants

  • Occupational, physical, respiratory and speech-language pathology therapies

  • Laboratory and pathology services

If the petitioner’s child needs Medicaid coverage, he or she will receive Medicaid services in Florida through the Child Health Check-up Program. How much is Medicaid’s coverage for these services? Free-of-charge check-up services include: regularly-scheduled health checkups, immunizations, dental health screenings and more.

Now that you have reviewed the scope of what is covered by Medicaid, candidates must also understand which services are not covered by Medicaid in Florida.

What does Medicaid not cover in Florida?

Are you unsure of what is not covered by Medicaid? If a beneficiary is enrolled in Medicaid coverage in Florida, it does not mean that all of his or her healthcare needs are automatically taken care of. Medicaid services that are not covered are at the state health department’s discretion. In this case, it is the Florida Department of Children and Families that weighs in on FL Medicaid coverage.

As it applies to Florida, certain Medicaid services require the signing and approval of a medical waiver. What are the Medicaid cost estimates for waiver-related services? Medicaid coverage will come into effect as a reimbursement for the following medical conditions and programs: adult cystic fibrosis, familial dysautonomia, iBudget, long-term care, Medicaid model, Project AIDS Care and traumatic brain injuries and spinal cord injuries. Each of these subjects allows the coverage of several related services, so long as you employ the proper medical assistance waiver prior to receiving a treatment or a procedure.

If a beneficiary elects to schedule a service that is not on his or her FL Medicaid coverage policy, then he or she must take the proper measures beforehand. With a doctor’s approval, the case may be approved. On the other hand, applicants may be responsible for partial costs. In the case where a candidate’s elective Medicaid services cost additional money, he or she can also discuss a payment plan. How much does Medicaid cost when your medical services are not covered? The simple answer is that the prices will vary, depending on your health condition, your medical needs and your finances.

Types of Medicaid Insurance for an Additional Cost

Now that you have reviewed the Medicaid services both covered and not covered, you may be wondering if there is any gray area left in the middle. If an applicant’s necessary services are not 100 percent covered, or if you are not eligible for Medicaid in Florida, you may be in a position to receive partial Medicaid coverage. How much is Medicaid’s associated partial programs? The following programs employ a cost-sharing mentality for your benefit if you cannot enroll in Medicaid types of insurance:

The Medically Needy Program – If an applicant does not qualify for full Medicaid coverage in Florida because his or her income or assets are over the federal poverty limits, he or she may be able to receive admission to the Medically Needy Program. Note that you must have a certain amount of medical expenses each month in order to receive approval. The Medically Needy Program is considered a cost-share program, but it also varies by patient, depending on both the household size and the income statements. Keep in mind that there are limits in place regarding the cost-sharing allotment which can be reported per month.

Emergency Medical Assistance for Non-Citizens – If the applicant is not a U.S, citizen or does not have legal presence to live in the U.S., Florida offers emergency medical coverage to certain individuals. If the candidate otherwise qualifies for Medicaid, he or she can request coverage regarding emergency medical services. Petitioners must include an authorized letter from a medical professional, along with the date of the medical emergency in order for reimbursement to be considered.

Medicaid/Medicare Buy-In Program – This savings program can assist Medicaid/Medicare-eligible beneficiaries with limited incomes pay for medical expenses related to premiums, co-pays and deductibles. There are options for both individuals as well as couples, depending on your income. You must fill out the designated application in order to utilize this buy-in program.

Florida Discount Drug Card Program – If an applicant is not eligible for Medicaid coverage, he or she can still receive financial assistance when it comes to prescription drug needs. Accepted at more than 600,000 pharmacies across the U.S., all the applicant needs to do is print the card to start saving through the Florida Discount Drug Card Program.



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