UPDATE: In 2020, Medicaid will have most of the same requirements and application steps detailed below.
Are you curious about what services are covered by Medicaid in Alabama? Each state provides its own unique range of services to its citizens, apart from the federally appointed medical commodities available in every state.
As such, costs and coverage may vary depending on the services needed and the income of the recipient. Even though Medicaid coverage is assumed to be free for people with a low enough income, it is important to remember that sometimes, Medicaid cost estimates will include deductibles, coinsurance and copayments.
Overall, the payments imposed by the state will depend on what types of Medicaid insurance a patient elects. A small part of the overall payment for service, or a copayment, is typically required. The remainder of the fee will be compensated by the Medicaid program. Understanding what services are covered by Medicaid depends on the state-specific guidelines. In this section, we cover the following:
- What is Covered Under Medicare in Alabama?
- What Does Medicaid Not Cover in Alabama?
- About Duties and Rights for Medicaid Patients in Alabama
- How Does Coverage Differ from Medicare?
What is covered under Medicaid in Alabama?
Medicaid coverage depends on what program a recipient chooses. However, it is important to note that most coverage includes hospital stays, home medical care and standard health tests.
All Medicaid services are provided by healthcare professionals working inside nursing homes, rural health clinics, drug stores, hospitals and doctor’s offices. The Alabama Medicaid agency will be able to confirm exactly what services are covered by your specific Medicaid plan.
What specific services are covered by Medicaid?
- Preventive Health Education Services
- Eye Care Services
- Home Health Services
- Hospice Services
- Inpatient Hospital Care
- Outpatient Hospital Care
- Psychiatric Hospital Services
- Mental Health Services
- Maternity Services
- Laboratory and X-Ray Services
- Ambulance Services
- Non-Emergency Services
- Transplant Services
- Medicaid approved Prescription Drugs
- Renal Dialysis Services
In some cases, a recipient may qualify for Medicare, as well as certain types of Medicaid insurance. These recipients will be called “dual eligibles,” which is a status that affords certain advantages. For instance, the Medicare Prescription Drug Plan funding usually goes hand-in-hand with being a “dual eligible” beneficiary.
What does Medicaid not cover in Alabama?
Residents of Alabama should learn about specific Medicaid coverage, but also what the Medicaid program in the state does not cover. A number of services are not included in the program, including:
- Dental services for adults aged 21 and over
- Dental services for pregnant women
- Cosmetic procedures and surgeries
- Hearing services for adults aged 21 and over
- Infertility services or treatment
- Hospital room TV/VCR rental
- Respiratory therapy
- Speech therapy
- Occupational therapy
- Recreational therapy
- Self-help devices
- Custodial care
- Assistive communication devices
What does Medicaid not cover? In addition to the above, services over-the-counter drugs are not covered by Medicaid. Furthermore, Medical coverage will not be granted to persons in prison or jail. Nevertheless, exceptions do apply in some cases. For example, a special case would be if the service is medically necessary.
With hospital inpatient and outpatient care included in state Medicaid coverage, serious and life-threatening medical issues will be dealt with by healthcare professionals, regardless of the beneficiary’s socioeconomic status.
About Duties and Rights for Medicaid Patients in Alabama
The rights of all recipients of Medicaid coverage is recognized by all healthcare providers in Alabama. Patient courtesy and respect can be expected with all types of Medicaid insurance. Patients will be informed of any rules or regulations that apply to their conduct, as well as diagnosis, treatment options, alternatives, risks and prognosis. Finding out if the facility accepts the Medicare assignment rate is a must for any beneficiary of Medicaid coverage.
How does Medicaid coverage differ from Medicare?
While the names might be similar, what is offered by both types of medical insurance is actually quite different. Medicare is suited to beneficiaries who are 65 years of age or older, whereas the public-assistance program known as Medicaid is suited to Americans old and young. A recipient living in Alabama may qualify for one, both or none of the insurance programs.
Before Medicaid costs can be estimated, four key items are assessed that set each healthcare option apart and simplify the decision to become an enrollee. These include:
- Structure – Each state sets its own standards for Medicaid, whereas the federal government sets the standards for Medicare.
- Financing – Medicare is funded entirely by the government and Medicaid costs are split equally between state and federal governments.
- Requirements – Income is not taken into account for Medicare, which serves disabled and elderly Social Security beneficiaries. Medicaid coverage, on the other hand, is designed to assist low-income beneficiaries, including elderly people, pregnant women, disabled adults and children.
- Benefits – Perhaps the biggest advantage of Medicaid coverage is that Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) is included. What this means is that all children receive necessary medical care. Medicare lacks this benefit package for children, since the program is intended to help adults and the elderly, rather than children.