Cost and Coverage of Medicaid in Georgia

How much is Medicaid, and what services are covered by Medicaid? Georgia's Medicaid services program is quite restrictive in terms of eligibility when compared to Medicaid coverage in other states. In general, the income limits in Georgia are lower than those of other states. All-in-all, about 20 percent of Georgia's residents are uninsured or do not understand what is covered by Medicaid, which is why it is important to gain knowledge on the costs and types of Medicaid insurance in Georgia.

When it comes to finding out Medicaid cost estimates along with the Medicaid services available to you, examine the below topics:

  • How much is Medicaid in Georgia?

  • What services are covered by Medicaid?

  • What does Medicaid not cover in Georgia?

How much is Medicaid in Georgia?

When you want to estimate Medicaid costs in Georgia, it all starts with your personal Medicaid coverage. Simply put, Medicaid expenses vary from patient to patient. For instance, if you are deemed a low-income member and are within the income limits of the current Federal Poverty Line, you may be able to get full Georgia Medicaid coverage. On the other hand, if you do not fully qualify to have all of your medical expenses covered by Medicaid, you may be partially financially responsible. How much does Medicaid cost you annually? You may be asked to handle any co-pays for doctor visits you schedule and the medications you need. In addition, there’s the cost of a monthly health insurance premium that you may need to pay out of your own pocket. However, since you are enrolled in Medicaid, the cost of your monthly medical coverage premium, if any, will be a fraction of what a private health insurance enrollee pays each period.

In terms of more specific Medicaid payments you might need to make, those will come in the form of what is not covered by Medicaid. What does Medicaid not cover, exactly? Let’s first discuss what Medicaid services are, in fact, covered.

What services are covered by Medicaid?

Once enrolled, your Georgia Medicaid coverage will be outlined in the form of a membership packet you receive by mail. In these documents, you will find out what services are covered by Medicaid. Mandatory Medicaid services covered in Georgia are similar to those of other states, and include:

  • Doctor visits

  • Emergency room visits

  • Inpatient and outpatient hospital care

  • Lab tests

  • X-rays

  • Nursing home care

  • Home health care

  • Prescription drugs

  • Dental care for members up to the age of 21

No-cost, comprehensive types of Medicaid insurance are available through the state's PeachCare program for children up to age 18 if a family does not meet the traditional requirements of Medicaid in Georgia. This program is sponsored by the Georgia Department of Community Health in an effort to assist children from low-income households. However, PeachCare Medicaid services are only available to those who both do not meet eligibility requirements and reside in a household with a cumulative income up to, but no greater than, 235 percent of the Federal Poverty Level.

What does Medicaid not cover in Georgia?

What is not covered by Medicaid in GA, exactly? Even though there are many Medicaid services covered by the government-sponsored health program, there are several that the state has agreed to not cover. What this means is that if you have Medicaid, but choose to obtain a service that is not covered by your policy, then you will be responsible for paying, entirely. The following medical services are not covered by Medicaid types of insurance in Georgia:

  • Cosmetic surgery

  • Medical care provided by a family member

  • Chiropractic care

  • Dental treatment for patients 21 and older

  • Non-documented health services

  • Missed appointments

  • Acupuncture

  • Organ transplants

  • Individual nursing facility medical supplies/equipment

How much does Medicaid cost when services are not covered? Medicaid cost estimates for uncovered services vary. When your Medicaid policy does not cover the above services, you must plan to pay for any treatments/procedures out of your own pocket. Note that you should speak with both your physician and your medical provider prior to scheduling any appointments that are not covered by Medicaid. If you know you will not be able to afford a service in one lump-sum, then discuss the option of a payment plan with both involved parties. You might find that either your doctor or your Medicaid provider is willing to work with you on a regular schedule, so long as you plan on paying off the service in due time.



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