UPDATE: In 2020, the rules and steps related to applying for Medicaid are expected to remain the same.
What services are covered by Medicaid in Colorado? Medicaid services and equipment that are insured by the government-sponsored health program vary from state to state. So, what is covered by Medicaid in New York may not be covered in Colorado. Even though there are some mandatory overlaps enforced by the federal government, no one state offers the same Medicaid coverage in comparison to another.
How much does Medicaid cost? To estimate Medicaid costs varies depending on the patient. For some beneficiaries, Medicaid coverage in CO requires a monthly premium; others will not have to pay anything at all for medical services. If you live in the state and do not make enough money to afford the health care coverage options available on the private market, you may meet requirements for Colorado Medicaid.
For more information on Medicaid cost estimates on types of Medicaid insurance in Colorado, and for details on services and coverage, review the below sections:
- What Services are Covered by Medicaid in Colorado?
- What Does Medicaid Not Cover in Colorado?
- How Much is Medicaid in Colorado?
What Services are Covered by Medicaid in Colorado?
What is covered by Medicaid, exactly? You might expect that every type of Medicaid insurance covers the same services and equipment. The federal government requires that every version of Medicaid coverage encompass a set of basic services. However, every state has its own version of Medicaid. Beyond the mandatory Medicaid services, each state is free to develop its own mix of covered medical services.
Because the medical coverage can vary significantly from one state to another, it is important to understand what is covered by Medicaid in Colorado prior to applying and enrolling in this health care program. Colorado Medicaid coverage pays for a wide variety of services and equipment for eligible beneficiaries, such as:
- Doctor visits
- Outpatient surgeries
- Home health care
- Vision care
- Emergency room visits
- Hospice care
By downloading our in-depth guide, you will learn more about the coverage options for Medicaid.
Other healthcare services may be covered as well if your physician determines that they are medically necessary. If Medicaid denies a procedure or piece of equipment you need, you can always appeal the decision. Your appeal rights are spelled out in the paperwork you received when you signed up for Medicaid coverage in Colorado.
If you need a medical service that falls under what is not covered by Medicaid, and you want Medicaid in Colorado to pay for it, you will need to file an appeal. You will need a prescription from your doctor, and 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 file and process.
Note that children may be eligible for additional Medicaid services that adults will not qualify for, such as dental services. These services may include regular exams, teeth cleanings, X-rays or even oral surgeries in extreme cases.
What Does Medicaid Not Cover in Colorado?
While Medicaid coverage in Colorado insures beneficiaries for a number of helpful services, there are certain procedures and services that are not covered by Colorado Medicaid. The Colorado Medicaid program establishes covered services based on medical necessity.
Therefore, any service deemed not medically necessary will not be covered in Colorado. In addition, the following services are not covered by Medicaid:
- Cosmetic surgeries
- Experimental treatments
- Infertility services
- Chiropractic services
- Over-the-counter medications
Keep in mind that you can still receive these services, but you will need to pay for them yourself. If you cannot afford what is not covered by Medicaid in Colorado, speak with your doctor, your Medicaid provider, or both parties to discuss payment plan options. You may be pleasantly surprised to find that there is flexibility when it comes to paying for an elective medical service.
How Much is Medicaid in Colorado?
How much does Medicaid cost in Colorado? Unfortunately, there is no simple answer to help you estimate Medicaid costs. Many Medicaid beneficiaries pay nothing at all for certain types of Medicaid insurance, due to the fact that they earn low incomes.
If your income is above the pre-determined threshold, you may still qualify for Medicaid, but you will have to pay a portion of the cost of your coverage. The costs for Medicaid services may come in the form of monthly medical coverage premiums and co-pays for doctor visits and prescription medications.
In the event that there is a change in your household or income, be sure to report this to the state. Your Medicaid cost estimates might go down, and you may be eligible to receive additional types of Colorado Medicaid insurance.
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 to you, you may be able to work out an extended payment plan. The staff at the Colorado Department of Health and Family Services is there to help you, so go ahead and utilize their services when need be. Download our informative guide to learn more about Medicaid coverage and costs.