UPDATE: In 2020, Medicaid is not expected to undergo any significant changes.
What services are covered by Medicaid in Missouri? The Medicaid services and equipment covered vary from state to state. The types of Medicaid insurance services provided by Missouri Medicaid are different from those provided, in, say, Kansas. How much does Medicaid cost? Medicaid cost estimates also vary and depend on the patient at hand.
For instance, while Medicaid coverage in MO will come with a monthly premium for some beneficiaries, others will not have to pay anything for medical services. If you live in Missouri and do not make enough money to afford the types of health care sold on the private market, you may meet the eligibility conditions for Missouri Medicaid.
So, how much is Medicaid for covered patients? For more information on Medicaid coverage costs in Missouri, and for details on what services Medicaid does and does not cover, review the sections provided below, including:
- What Services are Covered by Medicaid?
- What Does Medicaid Not Cover?
- How Much Does Medicaid Cost in Missouri?
What Services are Covered by Medicaid?
You might expect all types of Medicaid insurance to cover the same services and equipment. In fact, the federal government requires that every version of Medicaid cover a set of mandatory services.
However, every state has its own version of Medicaid that caters to the patients residing there. When you go beyond the mandatory services, each state is free to develop its own roster of covered services.
Since insured Medicaid services can vary significantly from one state to another, review the list of what is covered by Medicaid, so you can get a good idea of the allowances prior to completing the Medicaid application process.
Missouri Medicaid coverage pays for a wide variety of services and equipment for eligible beneficiaries. These services include:
- Outpatient hospital services and diagnostics
- Full inpatient hospital and medical care through a clinic or a hospital
- X-ray and laboratory services administered by a physician, an X-ray facility or a clinic
- Home-based nursing services
- Dental health services
- Ambulatory, podiatry and audiology aids and services
- Organ transplant services
- Home-based and community-based care for patients with AIDS, disabilities and mental illnesses
- Healthy Children and Youth program services
Other medical services may be covered as well if your physician determines that they are medically necessary. If Medicaid denies you a procedure or piece of equipment, you can always appeal the decision.
Appeal instructions are outlined in the paperwork you received when you enrolled. If you need to book a medical appointment for a service that is decided as what is not covered by Medicaid, you will need to file an appeal if you want MO Medicaid to pay the cost on your behalf.
In addition, you will need a prescription from your doctor, and you may need some additional supporting documentation discussing why the service is necessary, how the service will benefit you and the alternative treatments available to you, if any at all.
Your Medicaid appeal can take several months to address, so make sure to plan ahead with the filing, if possible.
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?
While Medicaid coverage in Missouri insures beneficiaries for a number of helpful services, there are certain health procedures and pieces of medical equipment that Missouri Medicaid will not cover. The Missouri Medicaid program establishes covered services based on medical necessity.
Therefore, any medical service that is not necessary for your health will not be covered in Missouri.
The following services are categorized as what is not covered by Medicaid in MO:
- Cosmetic dental care and dentures
- Custodial or long-term care
- Cosmetic surgery and related procedures
- Hearing aids and fitting tests
- Foot care administered as a routine
You can still have these and other non-covered procedures done, but you will need to pay for these services out of your own pocket. Keep in mind, if you cannot afford services not covered by Medicaid, you can discuss a payment plan option.
You should take the time to have this conversation with your physician or your medical provider prior to scheduling your procedure or treatment.
How Much Does Medicaid Cost in Missouri?
How much is Medicaid in Missouri? The Medicaid cost estimates for patients who meet low income standards and all other Medicaid qualifications in Missouri may equal nothing at all.
Medicaid coverage in Missouri may take care of all of your healthcare costs if your individual income is less than $1,316 per month. For a couple, this threshold is $1,775 per month.
In every case examined, your income has to be less than the income limits set by the law in Missouri to receive full benefits. In addition, you must possess Medicaid hospital insurance.
If your income is above this threshold, you may still qualify for Medicaid services, but you will have to pay a portion of the cost of your coverage. The estimate Medicaid costs for partial MO Medicaid coverage varies depending on your situation.
You may be asked to pay a monthly healthcare premium, as well as to handle co-pays associated with doctor visits and any prescription medication you require.
If you cannot pay for your Medicaid coverage in MO, talk to a state healthcare caseworker, as you may qualify for additional financial assistance, especially if there have been any changes in your health, your income or your household. Even if there are no assistance programs available for you, you may be able to work out an extended payment plan.