Cost and Coverage of Medicaid in Illinois

What services are covered by Medicaid in Illinois? And, how much does Medicaid cost? First, note that insured Medicaid services and equipment vary from state to state. The types of Medicaid insurance are different as well. Medicaid coverage costs are similar across the nation and within the state for the most part. For instance, while Medicaid coverage in IL will come with a monthly premium for some beneficiaries, others will not have to pay anything for medical services. In July of 2016, Illinois Medicaid covered just over 1 million patients in Illinois. If you live in Illinois, and do not make enough money to afford the health care coverage sold on the private market, you may qualify for Illinois Medicaid.

For more information on Medicaid costs in Illinois, and for details on Medicaid coverage, review the sections below, which discuss the following:

  • What services are covered by Medicaid in Illinois?

  • What does Medicaid not cover in Illinois?

  • How much does Medicaid cost in Illinois?

What services are covered by Medicaid in Illinois?

What is covered by Medicaid, exactly? You might expect all types of Medicaid insurance to cover the same services and equipment. In fact, the federal government requires that every state’s Medicaid program cover a set of mandatory services. However, every state has its own version of Medicaid specifics. When you go beyond the mandatory services, each state is free to develop its own mix of covered health services. Because the coverage can vary significantly from one state to another, it is important to review the facts to find out if the state medical assistance program suits your needs. Illinois Medicaid coverage pays for a wide variety of services and equipment for eligible beneficiaries.

These services include:

  • Hospital inpatient care

  • Physician services including outpatient care

  • Emergency dental services

  • Optical services and optical supplies

  • Prescription drugs

  • Podiatry care for patients with diabetes

  • Hospice care

  • Short-term and intermittent home-based health services

  • X-ray, laboratory and other miscellaneous medical services

  • Nursing home care

Other medical services may be covered as well if your physician determines that they are medically necessary. If Medicaid denies you a procedure or a medical supply, you can always appeal the decision. Your appeal rights are spelled out in the paperwork you receive when you sign up for Medicaid.

If you need a service that is not covered, you will need to file an appeal. You will need a prescription from your doctor; you may need some additional supporting documentation explaining why you need the service, how the service will benefit you, and what, if any, alternative treatments are available. Depending on how busy the Medicaid department is, an appeal can take 3 to 6 months or more to process. It is always good to plan ahead for your medical needs whenever possible.

When it comes to Medicaid coverage in IL, children may be eligible for additional services that adults will not qualify for, such as dental care services. Some listed procedures and treatments may include regular exams, teeth cleanings, X-rays or even oral surgery, in extreme cases.

What does Medicaid not cover in Illinois?

While Medicaid coverage in Illinois insures beneficiaries for a number of helpful services, there are certain procedures and pieces of health equipment that Illinois Medicaid will not cover.

The Illinois Medicaid program establishes covered services based on what is medically necessity. Therefore, any service that is not deemed medically necessary will not be covered in Illinois. What does Illinois Medicaid not cover? To get an idea, review the below list:

  • Cosmetic surgery

  • Home remedies

  • Unapproved organ transplants

  • Autopsies

  • Reports required for legal and insurance reasons

  • Services provided by members of your family

  • Procedures that are not medically necessary

How much is Medicaid’s cost for the above? Medicaid cost estimates for services not covered varies. You can still have these services done, but you will need to pay out of your pocket. Keep in mind that if you want to schedule a medical procedure and/or treatment that is considered ‘what is not covered by Medicaid,’ you can request a payment plan from your doctor or your healthcare provider to make things easier on your wallet.

How much does Medicaid cost in Illinois?

How much is Medicaid in Illinois? Note that many Medicaid beneficiaries pay nothing at all for their coverage due to the fact that they earn low incomes. Medicaid in Illinois may cover 100 percent of your healthcare costs if your individual income is less than $981 per month. For a couple, this threshold is $1,328 per month. In every case, your income has to be less than the income limits set by the law in Illinois. In addition, you have to possess Medicaid hospital insurance.

If your income is above this threshold, you may still qualify for Medicaid, but you will have to pay a portion of the cost of your coverage.

What are the Medicaid cost estimates? Unfortunately, there is no absolute answer to this question. The amount you pay can change based on your income, the size of your household and the exact level of coverage you have.

To estimate Medicaid costs for your Medicaid bill is more clear-cut. You can pay your consistent monthly premium for your coverage electronically using your debit or credit card. You can pay in person or by mail using cash, check or money order. If you are fully covered by Medicaid, you will not need to worry about the cost of a monthly medical plan premium.

If paying for your Medicaid coverage ever becomes a financial burden, be sure to let your caseworker know right away; you may qualify for additional financial assistance, especially if your income, your health or your living situation has changed. Even if there are no assistance programs available for you, as mentioned above, you may still be able to work out an extended payment plan. Making a phone call and filling out paperwork is a small price to pay if you receive more Medicaid coverage in the end. The staff at Illinois Department of Health and Family Services is there to help you; before you get yourself into financial trouble, make the call and talk to someone.



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