Cost and Coverage of Medicaid in Maryland

How much does Medicaid cost in Maryland? Before determining Medicaid cost estimates, there are several factors to consider. The price of Medicaid coverage depends heavily on the types of Medicaid insurance applicants are seeking. In addition, what services are covered by Medicaid and what is not covered by Medicaid both greatly impact Medicaid costs in Maryland. So, how much is Medicaid in Maryland for covered patients?

To learn more about MD Medicaid coverage and costs, review the below sections, which outline:

  • What services are covered by Medicaid in Maryland?

  • What doesMedicaid not cover in Maryland?

  • Types of Medicaid insurance in Maryland

What services are covered by Medicaid in Maryland?

Medicaid coverage in Maryland is determined by both the federal and state governments. Although there are some Medicaid coverage services available nationwide, there are others that are state-specific, and only fall under the realm of Medicaid coverage in MD. If a medical service is deemed as covered by Maryland Medicaid, that means that a beneficiary is not required to pay the cost of the medical service needed. The point of what is covered by Medicaid is to ease the financial stressors on patients statewide, and to instead, provide free or low-cost medical assistance.

Medicaid in Maryland is dispensed through HealthChoice. Covered services include, but are not limited to:

  • Ambulance and emergency medical transportation

  • Services from ambulatory surgical centers

  • Dental services, vision care and hearing aids, if under 21

  • Family planning services

  • Diabetes care and kidney dialysis

  • Labs, X-rays, medical equipment and supplies

  • Early and Periodic Screening, Diagnosis and Treatment, if under 21

  • Home- and community-based services, hospice care and nursing care

  • Inpatient and outpatient hospital visits

  • Mental health care and substance use disorder treatments

Maryland Children’s Health Program (MCHP) provides Medicaid coverage for patients up to 19 years of age. The following Medicaid services are covered for children with Medicaid in Maryland: doctor appointments for checkups and sick visits, hospitalization, lab work and X-rays, immunizations, prescription medication, vision care and dental care (through the Maryland Health Smiles Program).

In addition to children, pregnant women also receive full dental coverage under what is covered by Medicaid in MD, as do adults in Rare and Expensive Case Management (REM). Standalone dental plans are also available through HealthChoice, but are only offered during the open enrollment period each year, which occurs in the fall months.

What does Medicaid not cover?

Although there is a wide array of Medicaid coverage in Maryland, there are services some that the state does not handle on a beneficiary’s behalf. And, it is important to note that the state can decrease services covered due to its budget. In addition, there are limitations in place regarding Medicaid coverage in Maryland.

Some specific services not covered under Medicaid that require fee-for-service payments include medical day care, different types of therapies for children, personal care and waiver services. Medicaid cost estimates vary for the above items

Regarding what is not covered by Medicaid, patients may be partially or fully responsible for costs, depending on their circumstances. For instance, if a medical service needed does not fall under Medicaid coverage in MD, the beneficiary is responsible for paying the price out-of-pocket. How much does Medicaid cost under these circumstances? Although it is difficult to determine Medicaid cost estimates when a medical service is not covered, there are options, considering recipients are low-income beneficiaries that are medically needy. Examples of Medicaid cost-related items may include co-pays for certain types of doctor visits and elective treatments/procedures, co-pays for experimental medication not under Medicaid coverage and monthly health care policy premiums for those who have higher incomes than Maryland Medicaid allows, but elect to “spend-down.”

How much is Medicaid if paying for additional services? If patients should find themselves in a situation where medical services are not under Medicaid types of insurance, there are steps to take. First, speak with the doctor to see if he or she can sign off on the service as being medically necessary. There are instances when the state offers coverage with a doctor’s consent. The next step is to speak with a medical policy representative about possible Medicaid coverage for the service. If both parties deny the coverage of a service not covered by Medicaid, speak to them about a possible payment plan, so the medical service does not cause immediate financial pressure for your household or you.

Types of Medicaid Insurance in Maryland

Mainly, Medicaid coverage in MD is dispensed through HealthChoice, which is the Managed Care Organization (MCO) program of the state. All Medicaid recipients, as well as Maryland Children’s Health Program beneficiaries are enrolled in an MCO. Under the MCO, beneficiaries become members, and thus, receive the health services they need. MCOs in Maryland provide 100 percent, full Medicaid coverage to all members. Some MCOs may even elect to offer additional benefits. The main purpose of these types of Medicaid insurance organizations is to catch smaller health problems before they grow, which is why so many different Medicaid services are cited to receive coverage.

After being accepted into Medicaid coverage in MD, members must then take the time to select an MCO to join. If patients already have doctors, then they will join the MCO to which their current doctor belongs. If not, new beneficiaries can take the time to select the MCO types of Medicaid insurance in Maryland most suitable. If a patient does not choose a health plan, an MCO is assigned by the state. Beneficiaries have 21 days to sign up for a MD Medicaid coverage plan under an MCO after receiving enrollment information.

Other nontraditional types of Medicaid insurance plans in Maryland include: the Women’s Breast and Cervical Cancer Health Program, Maryland Children’s Health Program Premium and the Maryland AIDS Insurance Program.

The Maryland Pharmacy Assistance Program exists for patients who do not qualify into MD Medicaid, but still need help with medical expenses. In addition, overqualified patients who make too much money to apply for Medicaid can choose to “spend-down,” to receive medical assistance, so long as the excess income above the limit is proven to be spent on medical bills.



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