Cost and Coverage of Medicaid in Idaho

How much is Medicaid in Idaho? Regardless of whether patients receive full Medicaid coverage, there are health-related services taken care of by Medicaid and services that are not. What is covered by Medicaid depends on the different types of Medicaid insurance available to a particular benficiary. Some Medicaid services are only partially covered, and require out-of-pocket payments by beneficiaries.

Learn how to estimate Medicaid costs based on what is not covered by Medicaid in Idaho by reviewing the below sections:

  • What services are covered by Medicaid in Idaho?

  • What does Medicaid not cover in Idaho?

  • Types of Medicaid insurance in Idaho?

  • How much does Medicaid cost in Idaho?

What services are covered by Medicaid in Idaho?

What is covered by Medicaid in Idaho? Medicaid services covered vary depending on the different types of Medicaid insurance. Since Medicaid services, both covered and not covered, are determined on a state-to-state level, it is common to come across differences in Medicaid coverage plans. For some, Medicaid coverage in Idaho encompasses full medical coverage for designated procedures and treatments. However, even those fully qualified under ID Medicaid can still incur monetary charges if what is not covered by Medicaid becomes medically necessary.

The following medical services are covered by Medicaid in Idaho:

  • Dental care, vision care and hearing services

  • Doctor visits

  • Home health services

  • Hospital services

  • Interpretation services

  • Medical equipment and supplies and prescription drugs

  • Behavioral health services, substance abuse disorder services

  • Annual physicals, Well-Child checks and immunizations

  • Lead screenings

  • Physical, occupational and speech therapies

In addition to the above, other Medicaid services taken care of through Medicaid coverage include: nutritional services for pregnant women and children, doctor-ordered nutritional support therapy when medically necessary and diabetes training. Patients under the age of 21 can receive additional services covered by Medicaid, so long as they are deemed medically necessary and receive prior authorization from a Medicaid policy representative.

What does Medicaid not cover in Idaho?

Even though Medicaid services cover a wide range of treatments, procedures, medications and equipment, there are still certain services that do not qualify for Medicaid coverage in Idaho. When it comes to what is not covered by Medicaid, in most cases, patients are required to pay small co-pays.

Some of the medical services that are considered as not routinely covered by Medicaid include:

  • Emergency room visits not due to an emergency

  • Use of emergency medical transportation not due to an emergency

  • Chiropractic care (beyond the limit of six visits)

  • Optometry

  • Podiatry (unless under severe conditions)

  • Some doctor visits

Note that if a doctor makes the decision to perform an emergency treatment, patients are not required to pay co-payments for services used throughout that treatment.

If asked to handle a co-payment for a medical service not under Medicaid coverage, be sure to discuss options with both doctors and medical providers. Sometimes, non-covered health services can receive authorization if determined as medically necessary. In addition, payment plans are commonly leveraged if a patient cannot pay for a medical-related service that is not covered, so inquire about financing options if the situation arises.

How much does Medicaid cost in Idaho?

To estimate Medicaid costs can be difficult if patients are not eligible to receive full Medicaid benefits in the state of Idaho. How much is Medicaid when costs are incurred? It is difficult to determine the fees for medical services that are not covered, or are only partially covered. These decisions are made based on a beneficiary’s household income, as well as his or her medical condition/needs.

How much is Medicaid if children do not have full Medicaid benefits? For children that do not have full ID Medicaid coverage, monthly payments in the form of a medical insurance premium might apply. Medicaid cost estimates on the Basic Plan for children is up to $15, depending on the monthly income of a household. In addition, an elective monthly health care premium may be asked of a household if a child qualifies for the Home Care for Certain Disabled Children Program. The head of the household will receive a letter discussing the voluntary health care premium based on income. If patients or caretakers of patients cannot pay a suggested health coverage premium, this does not affect the general Medicaid coverage of a child.

What types of Medicaid insurance incur costs to the elderly and the disabled? Cost-sharing fees may apply to those who receive Aged and Disabled Waivers or Developmental Disability Waivers. This means that patients under these circumstances may be responsible for handling small co-payments for any services received under those designated medical assistance waivers.

Types of Medicaid insurance in Idaho

The reason that Medicaid cost estimates vary so much for patients in Idaho is because there are many different types of Medicaid insurance. Depending on Medicaid coverage and benefits, some patients have access to certain Medicaid services, and others do not. Take a look at the types of Medicaid insurance available in Idaho:

The Basic Plan – This Medicaid coverage encompasses preventative health services, all of which are outlined in the section discussing what is covered by Medicaid.

Preventative Health Assistance – Also known as PHA, weight management and wellness checks are the Medicaid services at the core of this health coverage plan.

The Enhanced Plan – All of The Basic Plan Medicaid services are included here, in addition to home- and community-based services, hospice care, nursing home coverage, personal care services, the coordination of services and women’s health checks.

Medicaid for Workers with Disabilities – This is an optional Medicaid coverage plan that includes all of the same Medicaid services offered under The Enhanced Plan, but is geared toward disabled patients.

The Medicare-Medicaid Coordinated Plan – This is also an optional Medicaid plan, but has some eligibility requirements attached to it. Patients must be above 21 years of age, enrolled in Medicare Part A and Medicaid Part B and enrolled in the Medicaid Enhanced Plan to receive this type of health coverage. Healthy Connections – This Primary Care Program provides team-based care led by a patient’s Primary Care Physician.



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