Learn About Coverage For Medicaid in Iowa

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UPDATE: In 2020, Medicaid will have most of the same requirements and application steps detailed below.

If you are wondering, “What services are covered by Medicaid in Iowa?” note that insured services and equipment will vary from state to state. The types of Medicaid insurance services provided by Iowa Medicaid will be different from those provided in other parts of the country. Furthermore, the question of, “How much does Medicaid cost?” varies similarly across the nation and within each state.

For instance, while Medicaid coverage in IA will come with a monthly premium for some beneficiaries, others will not have to pay anything for medical services. As of July 2016, Medicaid covered nearly 1.5 million residents of Iowa. If you live in Iowa, and do not make enough money to afford health care coverage sold on the private market, you may qualify for Iowa Medicaid.

For more information on Medicaid cost estimates in Iowa, and for details on what services Medicaid covers and what services it does not, review the sections provided below:

What Services are Covered by Medicaid in Iowa?

You might expect every type of Medicaid insurance to cover the same services and equipment. In fact, the Federal Government requires that every version of Medicaid must cover a set of mandatory services. However, every state has its own version of Medicaid. When you go beyond the mandatory services, each state is free to develop its own mix of Medicaid coverage.

Because the coverage can vary significantly from one state to another, you need to ask the question, “What services are covered by Medicaid in my state of residence?” to find out if the state medical assistance program suits your needs. Iowa Medicaid coverage pays for a wide variety of services and equipment for eligible beneficiaries. These services include:

  • Case management
  • Ambulatory services
  • Family planning and birth control services
  • Laboratory and x-ray services
  • Chiropractic services
  • Childbirth services and maternity care
  • Hospital care and urgent care
  • Emergency services
  • Nursing home services

Other services may be covered as well if your physician determines that they are medically necessary. If your Medicaid denies a procedure or piece of equipment, you can always appeal the decision. Your appeal rights are spelled out in the paperwork you received when you signed up. The process is pretty much the same in every state.

If you need a Medicaid service that is not covered, you will need to file an appeal. If you want to know how to qualify for Medicaid services which are typically covered, 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 3-6 months or more. It is always good to plan ahead for your medical needs whenever possible.

A child who is eligible for Medicaid may also receive additional services that adults will not qualify for, such as dental services. These services may include regular exams, teeth cleaning, X-rays or even oral surgery, in extreme cases.

What Does Medicaid Not Cover in Iowa?

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

The Iowa Medicaid program establishes covered services based on medical necessity. Therefore, any service that is not medically necessary will not be covered in Iowa. The following services are not covered:

  • Cesarean section (C-Section) deliveries
  • Non-Emergency Medical Transportation
  • Dietary supplements, leisure drugs, and alcoholic drinks
  • Services offered by members of your family or close relatives
  • Other services that are regarded not medically essential
  • Cosmetic, reconstructive or plastic surgery
  • Acupuncture
  • Surgery for obesity without prior approval

You can still have these services done, but you will need to pay for these services out of your pocket.

How Much Does Medicaid Cost in Iowa?

For those wondering, “How much is Medicaid in Iowa?” note that many Medicaid beneficiaries pay nothing at all for several types of Medicaid insurance, due to the fact that they earn low incomes. Medicaid in Iowa may cover 100% of your healthcare costs if your individual income is less than $981 per month. For a couple, this Medicaid cost estimate threshold is $1,328 per month. In every case, your income has to be less than the income limits set by law in Iowa. In addition, you have to possess Medicaid hospital insurance.

If your income is above this threshold, you may still meet Medicaid requirements, but you will have to pay a portion of the cost of your coverage. The next logical question is, “How much does Medicaid cost?” Unfortunately, there is no absolute answer to this question. Medicaid cost estimates vary by the beneficiary’s needs and financial situation. The amount you pay can change based on your income, the size of your household and the exact level of coverage you have.

Paying your Medicaid bills is more clear-cut. You can pay 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 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, health or living situation has changed. Even if there are no assistance programs available for you, you may be able to work out an extended payment plan.

If you need medical insurance, but you cannot afford it, Medicaid could be a good option for you. The coverage you receive may vary, depending on what state you live in, but the basic services you and your family depend on will always be included in your plan. The price you pay for your benefits can vary as well. Many beneficiaries will pay nothing for their coverage. If you cannot pay the cost of healthcare on your own, Medicaid may be the answer you are looking for.