Learn About Coverage For Medicaid in Michigan

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How much is Medicaid in Michigan? When examining Medicaid cost estimates, the prices vary depending on each patient.

The types of Medicaid insurance can receive are based on state eligibility requirements. For example, your Medicaid coverage may cost less than that of your neighbor’s if you earn a lower income and have more family members residing in your home.

How much does Medicaid cost in Michigan for children and adults? The price also varies depending on the ages of the beneficiaries in your home.

If you want to learn more about the Michigan Medicaid coverage, continue to the below sections, which discuss:

What Services are Covered by Medicaid in Michigan?

When you complete the application process for Medicaid coverage in Michigan and receive approval, you will receive a mihealth card for both adult and child healthcare programs.

Your mihealth ID card only confirms that you are a beneficiary of Medicaid services. It does not serve to cover your medical expenses. You will still need to have your medical provider confirm what is covered by Medicaid upon each and every healthcare visit you make.

If you are an MI Medicaid coverage beneficiary, the expenses of your Medicaid services will be handled on your behalf. The health services deemed covered and medically necessary under Michigan Medicaid include:

  • Ambulance and non-emergency medical transportation
  • Emergency services
  • Family planning and pregnancy services
  • Home healthcare, nursing home care personal care services, private duty nursing and hospice care
  • Immunizations, labs, X-rays and medical supplies
  • Mental health services
  • Substance use disorder treatment services
  • Physical and occupational therapies and chiropractic services
  • Hearing and speech services
  • Surgeries

Types of Medicaid insurance also cover an annual wellness checkup in Michigan. In addition to the Medicaid services noted as medically necessary, there are several services listed through Michigan Medicaid that are partially covered.

How much does Medicaid cost when it is not 100 percent covered?

These fee-for-service inclusions mean that you will only be responsible for a minimal co-pay (most are less than $5 each) if you elect any of the following:

  • Physician office and free-standing urgent care center visits
  • Outpatient hospital clinic visits
  • Emergency room visits for both emergency and non-emergency services
  • Inpatient hospital stays
  • Pharmacy costs
  • Chiropractic care
  • Dental visits
  • Hearing aids
  • Podiatric visits
  • Vision appointments

If you are receiving nursing home care or inpatient hospital services, you may be responsible for paying some of the Medicaid coverage amenities. Your specialist will advise you on whether or not you will need to pay for the partial costs of these services.

How much is Medicaid for children in Michigan? If you have a child enrolled in MIchild Medicaid coverage in Michigan, you must pay an annual healthcare premium totaling $120 per household ($10 per month).

However, even though you must pay for a health care premium, you will have no co-pays when it comes what services are covered by MI Medicaid. Note that the Medicaid healthcare premium price is set at $120 per year, no matter if you have one child or three children covered under MIchild in your household.

What Does Medicaid Not Cover in Michigan?

As a recipient of Medicaid coverage in Michigan, as you can see, there is a wide array of medical services available to you at little-to-no cost at all. However, there are healthcare services identified as what is not covered by Medicaid.

For example, if you go over the annual cost-sharing allowance you are given (which is set at 5 percent of your household income every three months), Medicaid services normally covered may incur a charge. Additionally, you may be facing added Medicaid cost estimates when you go over other set limitations.

For example, any Medicaid beneficiaries above the age of 21 may be subject to certain limitations regarding the coverage of above healthcare services. How much does Medicare cost if you exceed limitations?

Speak with your healthcare provider directly prior to receiving any of the above, so you have a fair idea on how to estimate Medicaid costs beyond your designated coverage.

Keep in mind that if you decide to undergo treatment, a therapy or a procedure that is not covered by the Medicaid services in Michigan, it is in your best interest to speak with both your healthcare provider and your physician, first.

You may be able to discuss options related to payment plans that will help ease financial stressors. If you are adamant about receiving a medical service that is not taken care of by your Medicaid coverage and that you cannot otherwise afford, survey your options before booking that service.

In the state of Michigan, all Medicaid beneficiaries have the right to an appeal if MI Medicaid coverage is reduced or medical service requests are met with a denial. If Medicaid or MIChild does not pay your medical bill or refuses to cover a medical service needed by a qualified patient, he or she has the right to appeal within 90 days from the date of the denial.

If you have any questions about the appeals process, be sure to speak with a representative from the Michigan Administration Hearing System for the Department of Health and Human Services.

How to Review Medicaid Coverage Information

The types of Medicaid insurance vary, which is why it is important for beneficiaries to be able to access their own personal Michigan Medicaid coverage policies regularly. You can access mihealth portal in Michigan any time of day to review the Medicaid services covered by your healthcare policy.

Check your Medicaid coverage at any time, even from a mobile phone. The health coverage information you can look up through myHealthPortal ranges from your primary care physician to your current health plan, along with additional health insurance information, other health care providers and advance directives.