Learn About Coverage For Medicaid in Arizona

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UPDATE: For 2020, no significant changes were made to Medicaid.

How much does Medicaid cost, and what services are covered by Medicaid? Arizona’s version of Medicaid coverage is called the Arizona Health Care Cost Containment System (AHCCCS). Not everyone will receive the same types of Medicaid insurance, even though Medicaid eligibility requirements may seem similar.

Additionally, Medicaid cost estimates will vary depending on your financial situation and your medical conditions. For those who are fully covered, Medicaid services may be of no cost to you. On the other hand, if your AZ Medicaid program does not handle the full cost of your medical needs, you may be subject to payments.

How much does Medicaid cost when you are not entirely covered? Costs will vary, but you may be required to make payments related to monthly healthcare premiums and doctor- and drug-related co-pays. Want to learn more about what is covered by Medicaid in Arizona? Review the below sections, which outline in detail:

What services are covered by Medicaid in Arizona?

Regarding what is covered by Medicaid, services are available to different patients through several types of Medicaid insurance plans. Arizona Medicaid coverage takes care of basic healthcare services, like visits to the doctor, lab work, X-rays, immunization shots, prescription drugs (this is not covered if the member has Medicare), hospital Medicaid services, pregnancy care, emergency care, transportation to the doctor, specialist care, physical exams, surgery services, family planning services and behavioral health.

Children age 21 and under receive Medicaid coverage in Arizona that includes vision exams and glasses, hearing exams and hearing aids, along with dental screenings and dental treatments. Now that you are familiar with the basic Medicaid services covered in Arizona, it is equally important to understand what is not covered by this plan.

What does Medicaid not cover in Arizona?

Even if you have 100 percent Medicaid coverage through specific Medicaid types of insurance, there are still medical treatments and procedures that are not handled by the state’s healthcare initiative. Arizona Medicaid does not cover medical services provided by a member’s family or friends. Moreover, it does not cover plastic surgery or any other aesthetic treatment to improve one’s looks.

In addition, Medicaid services not covered in Arizona include private-duty nursing, medical experimental items or chiropractic care. Even still, domiciliary care is not included in AZ Medicaid coverage, and neither are funerals and cremation services.

If you elect to schedule a service that falls under what is not covered by Medicaid, it is important to discuss this ahead of time. If you want to schedule a medical procedure or a treatment that is not under your Medicaid coverage policy, consider the following:

  • Speak with your doctor to see if he or she can write a letter of authorization stating that the medical service should be covered on your behalf.
  • Discuss your decision with a representative from your medical policy team to hear out your options..
  • Explore the possibility of a payment plan if you cannot afford the cost of the medical service in full.
  • Talk to your doctor about the urgency or the necessity of this medical service if you simply cannot afford the bill.

Since the price tag of medical services not on your Medicaid coverage can be set exceptionally high, it is important to explore all of your options prior to scheduling your elective medical appointment. If your doctor or your policyholder insists that a service that is not covered should, in fact, be covered, you can consider filing an appeal with the state, if you so choose.

How much is Medicaid in Arizona?

Since you qualified for Medicaid coverage in Arizona as a low-income patient, you will never be subject to paying high-cost medical bills. Out-of-pocket costs will only be required if the member obtains treatment outside of the scope of Medicaid, as outlined in the section above.

Keep in mind that Medicaid cost estimates for particular Medicaid services are minimal amounts, or in some cases, nominal amounts. If you are required to make payments regarding Medicaid coverage in AZ, it is likely due to a health plan premium or a co-pay, which can relate to a doctor visit or a necessary prescription drug.

It is difficult to fully estimate Medicaid costs, as it truly depends on your medical circumstances and the types of Medicaid insurance plans offered in Arizona. Keep in mind that, generally, if you fully qualified for Medicaid coverage in AZ, you will not be responsible for paying any medical costs when Medicaid services are listed as covered.

What is spending down on Arizona Medicaid coverage?

Medicaid coverage in Arizona is not available for all applicants, as not every petitioner will qualify. Nevertheless, it is possible to obtain health care services under the federal government and the state-funded program if you are willing to “spend-down.” What this means is that you will put some money toward the Medicaid coverage, like an excess.

This “excess” will match the amount that overqualified you on your income threshold during your eligibility screening. Once enough money has been spent on your medical- and health-related bills, like prescription drugs, your Medicaid services in Arizona will become active.

Spending down is a popular option among Arizona residents who own countable resources that leave them out of Medicaid coverage policies. The Community Spouse Resource Allowance (CSRA) varies by state and usually includes household goods, life estate interests and retirement funds.