Learn About Coverage For Medicaid in Nevada

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UPDATE: In 2020, the rules and steps related to applying for Medicaid are expected to remain the same.

Nevada Medicaid services help low-income individuals and families get affordable health care in the state. The Medicaid coverage program provides some services for free while others are offered at a low cost.

“What does Medicaid not cover?” is a common question among people who wish to apply for the program. In addition to what is covered by Medicaid, applicants are also concerned with Medicaid cost estimates. The following sections provide detailed information regarding NV Medicaid:

How Much Does Medicaid Cost in Nevada?

NV Medicaid cost estimates vary depending on the individual and services sought. The estimate Medicaid costs discussed below do not apply to pregnant women or members who are 18 years of age or under. Pregnant women are eligible for free health services up to their post-partum period.

How much is Medicaid? The Medicaid cost estimates for copayments range from zero to a few hundred dollars depending on the service required. The majority of copays are less than $30, with basic services only costing a few dollars. However, copays can be revised from time to time, as plans and costs are evaluated regularly.

Some Medicaid coverage programs like preventive health services, emergency services, and family planning services are free of cost. Your Medicaid cost estimates in NV can change depending on any number of events.

For example, a change in income level or family size may entitle a recipient to pay less copay. Inform your Medicaid coverage health plan (managed care organization) of any changes that can affect your benefits as soon as possible. Download our informative guide to learn more about Medicaid coverage and costs.

What Services are Covered by Medicaid in Nevada?

The Nevada Medicaid program services a wide range of patients with unique medical needs and ailments. To accommodate for the wide spectrum of patient ages and needs, Medicaid has a full-service suite, from an ambulance to a general practitioner, hearing and vision, dental and more. Medicaid coverage includes the following:

  1. Ambulance/Transportation – NV Medicaid services program covers air and ground ambulance services in a medical emergency. The medical services must be offered by providers that have a contract with Nevada Medicaid.
  2. Family planning/Birth control – Members can receive family planning services from any in-network provider. The services do not require a referral. Your Medicaid coverage doctor can prescribe some types of birth control or offer them in his or her office. Medicaid covers the following birth control supplies: sponges, shots (Depo-Provera), Norplant, IUDs, foams, diaphragms, creams, condoms and birth control pills.
  3. Dental benefits – Nevada adults are only covered for emergency dental care. On the other hand, children and pregnant women are eligible for certain periodontal benefits and limited orthodontia. Some dental procedures require prior authorization.
  4. Medical supplies – NV Medicaid coverage allows beneficiaries to obtain many medical supplies required for medical reasons. The program covers durable medical equipment (DME) and disposable medical supplies. Supplies that may be covered include wheelchairs, walkers, crutches and canes, incontinent supplies, wound care supplies, oxygen, and prosthetic orthotic devices. Some items require prior approval from NV Medicaid for them to be covered.
  5. Doctor visits – NV Medicaid services program caters for visits to a doctor’s office or Urgent Care Clinic when you have health problems. If needed, your primary care provider can refer you to a specialist.
  6. Emergency room – When you have a medical condition that cannot wait for a regular medical appointment, it will be covered by Medicaid. No prior authorization is required when you have an emergency medical condition. However, you will need to inform your PCP when the emergency is over.
  7. Vision services – Nevada Medicaid coverage also includes vision health services, including eye exams and eyeglasses. Coverage for eyeglasses and eye exams is restricted to once every 12 months. Contact lenses may be covered if they are deemed medically necessary.
  8. Early Periodic Screening Diagnosis and Treatment (EPSDT) – EPSDT, also known as Healthy Kids, is a special program for Nevada children enrolled in Medicaid. The program covers medical checkups for children until they reach 20 years of age.
  9. Hearing tests – Child and adult hearing tests are also covered by NV Medicaid. Newborn hearing tests (federally required) are included in hospital stays.

Medicaid coverage NV program also covers the following: hospice and hospital care, immunization and prescription drugs, lab tests and X-rays, mental health and substance abuse services, midwife services and maternity care, nursing home services and private duty nursing, smoking cessation and transportation services.

What Does Medicaid Not Cover in Nevada?

What is not covered by Medicaid? NV Medicaid coverage excludes the following services:

  • Use of emergency room for routine or non-emergency treatments
  • Services provided by a doctor from out-of-state or that is not in the Medicaid coverage plan’s network
  • Services not deemed as medically necessary
  • Drugs, treatments or procedures considered experimental
  • Personal effect items such as a TV or telephone during a stay in the hospital
  • Cosmetic or elective surgery
  • Abortion, except when it is necessary to save the mother’s life
  • Home therapy, New Age, Christian Science treatments
  • Services that have not been approved for by your Medicaid health plan
  • Services that have already been covered by other insurance, such as Medicare or Veteran’s Assistance

Confirm with your provider whether the health service you want is covered by Medicaid.

Learn About Types of Medicaid Insurance in Nevada

There are different types of Medicaid insurance for which enrollees can apply. The insurance plans are provided by two managed care organization (MCOs). The organizations are the Health Plan of Nevada and AMERIGROUP Community Care.

When the NV Medicaid coverage application is approved, he or she will have to choose one of the health plans. Depending on the type of insurance the applicant chooses, he or she will get health care services through the plan’s network of providers. If the approved applicant does not select a plan, one will be selected for him or her.

By downloading our in-depth guide, you will learn more about the coverage options for Medicaid.