Learn About Coverage For Medicaid in Minnesota

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UPDATE: For the year 2020, Medicaid plans will follow the same requirements and application methods.

How much does Medicaid cost in Minnesota? Full Medicaid coverage is granted to certain qualified patients, while others may be required to pay fees in the forms of deductibles or co-pays for certain Medicaid services.

And, while what is covered by Medicaid means little-to-no-cost for beneficiaries, there are some medical services that are considered what is not covered by Medicaid in MN. How much is Medicaid when a health service is not handled by the government?

Medicaid cost estimates vary depending on the patient and the types of Medicaid insurance. Learn more about MN Medicaid coverage and costs through the topics outlined below:

How Much Does Medicaid Cost in Minnesota?

How much is Medicaid in Minnesota? If patients qualify for full Minnesota Medicaid coverage, then costs are next to nothing.

When Medicaid services do not apply 100 percent of the time, beneficiaries are responsible for taking on certain costs. The following patients are not responsible to estimate Medicaid costs through their government health care policies:

  • Children under age 21
  • Pregnant women
  • Those under hospice care
  • Those in a nursing home other than for long-term care that resides for more than 30 days
  • Qualified Native Americans
  • Those who qualify for certain services under Medicare
  • Refugees under the coverage of the Refugee Medical Assistance Program
  • Those who need family planning services
  • Patients who need prescriptions for mental illnesses
  • Those who elect to receive preventive services under the United States Preventative Services Task

Beneficiaries not listed above may be subject to Medicaid cost estimates in the forms of co-pays, deductibles and coverage limits through the Minnesota Department of Human Services.

Regarding health care premiums for Medicaid coverage, these are determined based on a patient’s household size and income. Those who do not ever have to pay premiums for Medicaid services are children under the age of 21, homes that house Native American enrollees and certain military families for up to 12 months.

Medical Assistance for Employed Persons with Disabilities (MA-EPD) requires low premiums from disabled, working patients in Minnesota who need health coverage. And, even though children with disabilities can qualify into full MN Medicaid coverage, their parents may be required to pay monthly fees for Medicaid services.

If a MN Medicaid coverage candidate earns more per year than the income limit allows, he or she may still be able to qualify for medical assistance through the spend-down program. Spend-downs allow patients to deduct medical expenses from income. Once the earnings reach the income limit, Minnesota Medicaid will pay for medical expenses.

What does Medicaid not cover in MN? These types of medical services are generally elective by the patient, and are categorized as medically unnecessary by the state.

A medical service is noted as what is not covered by Medicaid, speak with a doctor or are health care representative to discuss any financial responsibilities associated prior to scheduling an appointment.

These types of medical services are generally elective by the patient, and are categorized as medically unnecessary by the state.

What Services are Covered by Medicaid in Minnesota?

Medicaid services covered through a government-sponsored health care program vary, and are determined on a state-by-state basis. While MN Medicaid coverage might take care of a wide range of medical services, a neighboring state may not.

Even though what is covered by Medicaid differs, there are several medical services that are deemed mandatory by the federal government, and thus overlap from program to program. The following medical services are considered covered under full Minnesota Medicaid coverage:

  • Dental care (there are limits for patients who are not pregnant)
  • Chiropractic care and rehabilitative therapy
  • Doctor visits, clinic visits and associated labs, X-rays, immunizations and vaccines
  • Emergency room care and urgent care
  • Eyeglasses, hearing aids, other medical equipment and supplies and prescriptions and medication therapy management
  • Mental health care and drug and alcohol treatments
  • Medical-related transportation services
  • Family planning services
  • Inpatient and outpatient hospital care and outpatient surgeries
  • Home care, personal care assistance, hospice care and nursing home care

Understanding the Types of Medicaid Insurance in Minnesota

Patients fall into different Minnesota Medicaid coverage categories depending on the Medicare eligibility conditions and the applicant’s medical circumstances. Thus, certain types of Medicaid insurance were created to cater to specific patient groups.

The costs and Medicaid coverage under one health plan may differ from that of another. Review the Medicaid types of insurance plans offered via the categories listed below:

Medical Assistance (MA) – This is the designated plan for Medicaid coverage in Minnesota. The health care plan works to provide medical assistance for low-income, eligible patients. Beneficiaries enroll and then select health plans through the Medical Assistance network in their neighborhoods. MA serves children and families, pregnant women, adults who have no children, seniors, the disabled and the blind.

MinnesotaCare – This Medicaid coverage plan is similar to MA, but requires a monthly health care premium of its beneficiaries. It is meant for those who cannot qualify into MA and has a higher income level limit for eligibility.

Medical Assistance for home-based care through a waiver program – These types of Medicaid insurance waivers assist patients who need help with expenses that choose to stay at home, rather than live in a nursing home or a medical facility. Types of medical waivers include: Brain Injury Waivers, Community Alternative Care Waivers, Community Access for Disability Inclusion Waivers, Consumer Directed Community Supports, Developmental Disabilities Waivers and Elderly Waivers.

Health care coverage for nursing home patients – Those who need Medicaid Services and live in a nursing home receive coverage through MA. The government-sponsored health care policy also handles care received at designated intermediate care facilities for those who are developmentally disabled.

Medical Assistance for Breast or Cervical Cancer (MA-BC) – Women enrolled in the Sage Screening Program that needed breast or cervical cancer-related treatments receive Medicaid coverage through MA-BC. All costs are covered, so long as treatment is needed.

Minnesota Family Planning Program – Family planning services and supplies are covered under this health plan, which also includes transportation to and from family planning facilities. Patients can complete the application process for this program for a short-term period or for a year. Those interested in the Minnesota Family Planning Program cannot receive Medicaid coverage through MA.

Emergency Medical Assistance (EMA) – This is a fee-for-service plan that does not require patients to enroll in health plans in order to receive benefits. Emergency conditions covered include emergency room and hospital care, nursing home and home health care, ongoing treatment with the purpose of hospital prevention, renal dialysis and kidney transplants and cancer that is not in remission.