Cost and Coverage of Medicaid in Hawaii

Hawaiians who lack health insurance and earn a low wage or salary are encouraged to seek out information about Medicaid. The state’s version of Medicaid coverage is called Med Quest. By July of 2016, over 340,000 residents of Hawaii were enrolled in Medicaid services and CHIP, and were actively receiving HI Medicaid coverage. This figure represents nearly a 20 percent increase since the program’s alterations and initial Marketplace Open Enrollment Period launched in October of 2013. Part of the reason for the jump in Hawaii’s Medicaid coverage enrollment base can be attributed to recently expanded guidelines for Medicaid as a result of the Affordable Care Act’s (ACA) passage into law. The marketplace for types of Medicaid insurance recently transitioned to a federal government-supported marketplace operated by the state.

It is not just the eligibility criteria that varies by state, but also, what services are covered by Medicaid and the Medicaid cost estimates for beneficiaries. Some people will not be required to put any money towards deductibles, co-payments, co-insurance and premiums, whereas others might. The more you know about what services are covered by Medicaid in Hawaii, the less of a surprise it will be when you are enrolled in the program and request Medicaid services and assistance, whether it is at home or not.

Below, we go over the basics of Hawaii Medicaid cost estimates to give you a better understanding of what it is like to be a Medicaid enrollee:

  • Hawaii Medicaid Coverage Options for No-Cost Care
  • What is covered by Medicaid in Hawaii?
  • What is not covered by Medicaid in Hawaii?
  • Medicaid Cost Estimates in Hawaii
  • Medicaid Coverage Limitations in Hawaii
  • Spending Down to Qualify for More Medicaid Coverage in Hawaii

Hawaii Medicaid Coverage Options for No-Cost Care

Generally, the rules for Medicaid coverage eligibility outline that low-income families, low-income people, pregnant women, children, disabled people and the elderly will be able to receive types of HI Medicaid insurance at no cost. Furthermore, a certain income level must be met for state residents to be granted types of Medicaid insurance in Hawaii and the amount of owned resources must not be more than $2,000. Applicants who receive Supplemental Security Income (SSI) can also enroll in HI Medicaid coverage for no-cost care or low-cost care.

It should be noted that there is a distinction between traditional Medicaid services and CHIP. CHIP is an acronym that stands for Children’s Health Insurance Program. These types of Medicaid insurance were formed nearly 20 years ago to provide medical care to children in families that earn too much money to be eligible for Medicaid coverage yet cannot afford healthcare offered on the private market. CHIP and Medicaid are provided by Hawaii and jointly funded by the state and federal governments. The key to understanding what services are covered by Medicaid is figure out how both programs for adults and children are dissimilar, from the Medicaid cot estimates to the HI Medicaid coverage limitations.

It is also worth noting that Hawaii has a unique name for its Medicaid services program: MED-QUEST. QUEST is an acronym that means quality healthcare, universal access to healthcare, efficiency, stable costs and transforming the manner in which healthcare is provided. In the grand scheme of things, Hawaii is doing quite well in the context of types of HI Medicaid insurance offered to its citizens. Hawaii has been dubbed the “healthiest state” in the nation due to its high overall health grades and comparably low Medicaid cost estimates.

What is covered by Medicaid in Hawaii?

Hawaii Medicaid coverage pays for medical care, medical equipment and prescriptions that are necessary for the member’s general well-being. The primary Medicaid services provided by Hawaii Medicaid include care provided by a doctor, long-term care, hospital care, prescription drugs, family planning, medical equipment, X-rays, transportation for medical treatment/evaluation, lab tests and a limited amount of dental care.

What is not covered by Medicaid in Hawaii?

Knowing what does Hawaii Medicaid not cover will prevent surprises later down the line. Medicaid services are meant to pay for only the most essential assistance, medical equipment and prescription drugs. Cosmetic surgery of any sort will not be paid for by Hawaii Medicaid coverage. Furthermore, disposable medical items, such as adult diapers, chiropractic care, experimental items and private duty nursing, will not be on the list of what is covered by Medicaid.

Medicaid Cost Estimates in Hawaii

Since Hawaii Medicaid coverage is provided to those who earn little-to-no money, there is no cost for its medical services, medicines and medical equipment. Those who obtain medical services or equipment outside of those made available through Hawaii Medicaid will be forced to pay out-of-pocket. There are also some out-of-pocket expenses for certain long-term care services, such as co-payments, deductibles and coinsurance.

Out-of-pocket Medicaid cost estimates in Hawaii will not necessarily leave a recipient struggling to fund their medical services and healthcare, though. Nevertheless, failure to pay will leave the recipient feeling confused about how to estimate Medicaid costs and result in them being held liable for unpaid fees, like co-payments. Applicants who earn more than 1000 percent of the Federal Poverty Level (FPL) will be presented with an option to pay “alternative” out-of-pocket Medicaid coverage costs. Generally, these Medicaid cost estimates tend to be higher than the nominal charges, but it completely depends on the type of Medicaid services being received. For institutional and non-institutional care, recipients will need to pay around 10% of whatever the agency pays for the state’s Medicaid services and supplies.

Medicaid Coverage Limitations in Hawaii

“How much is Medicaid and are there limits?” is another question you must learn the answer to before applying. Just like with any other state’s rules relating to Medicaid coverage and costs, Hawaii Medicaid enrollment is based on income limits. These limits are based on the Federal Poverty Limit (FPL), as well as the size of the applicant’s family. There are no limitations associated with length of residency, as long as the legal resident is living in the State of Hawaii when Medicaid services are applied for. If you decide that you want to change your plan, you will have an opportunity to do so, once a year, in October.

Spending Down to Qualify for More Medicaid Coverage in Hawaii

In order to participate in Hawaii Medicaid coverage, the applicant can go down the route of spending down up to the amount of income that exceeds the threshold. For example, the Hawaii Medicaid cost estimates rules confirm that if someone earns $100 more than the annual income threshold, he or she will be able to “spend-down” $100 towards medical supplies, services and other types of HI Medicaid insurance products, such as over-the-counter prescription drugs.