Cost and Coverage of Medicaid in Texas

We are an online resource to help answer your questions, check your eligibility and assist you in applying for Medicaid. When you receive our guide, you will also be advised about whether you qualify for additional benefit programs.

Cost and Coverage of Medicaid in Texas

How much does Medicaid cost eligible enrollees in Texas? Medicaid cost estimates vary depending on the applicant’s eligibility group, the type of medical conditions needed and both the size of the household and monthly earnings statement.

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How much is Medicaid for services that are covered? Typically, Medicaid coverage in Texas requires little-to-no payment. What does Medicaid not cover in TX? An applicant may be fully responsible to pay your medical bills regarding services not taken care of by Medicaid.

Review the below information on Medicaid coverage for more details:

Types of Medicaid Insurance in Texas

Medicaid types of insurance can help candidates determine if the services needed are covered or not covered, based on the applicant’s patient group. Since there are several Medicaid coverage eligibility groups, it’s important to examine the types of Texas Medicaid insurance that apply to the petitioner’s medical condition.

Texas Medicaid coverage is offered to eligible applicants through the following programs:

  • Children’s Medicaid, CHIP and Medicaid Buy-In for Children
  • Medicaid for low-income pregnant women, CHIP Perinatal Coverage, Healthy Texas Women and Medicaid for Breast and Cervical Cancer
  • Medicaid for an adult caring for a child and Medicaid Buy-In for Adults
  • Medicaid for Former Foster Care Children and Medicaid for Transitioning Foster Care Youth
  • Medicaid for long-term care
  • Medicaid for those who receive Supplemental Security Income

Once you have reviewed the types of Medicaid insurance in Texas, the next step is to examine what is covered by each health care policy. By downloading our in-depth guide, you will learn more about the coverage options for Medicaid.

What Services are Covered by Medicaid in Texas?

Since there so many Medicaid coverage programs in Texas, it is important to review the differences of each. And, because Medicaid services are offered through multiple health plans, understanding what is covered can assist applicants with enrolling in the right type of Medicaid insurance plan for the petitioner. Here are the Texas Medicaid services covered, broken down by each medical assistance policy:

Children’s Medicaid and CHIP – Both of these policies cover doctor’s visits, lab tests and X-rays, vaccines, doctor-ordered drugs, glasses, hospital care, transportation to the doctor and dental care.

Medicaid Buy-In for Children – Medicaid coverage includes those services covered by Children’s Medicaid and CHIP, in addition to hearing care and several special needs services.

Medicaid for low-income pregnant women – This type of Medicaid policy for women covers doctor visits, drugs ordered by the doctor, hospital care, labor and delivery, dental care, transportation to doctor appointments, labs and X-rays and eye glasses.

CHIP Perinatal Coverage – Medicaid services and supplies taken care of on the beneficiary’s behalf include doctor visits, prenatal vitamins, prescribed drugs, labor and delivery and post-delivery checkups and benefits.

Healthy Texas Women – This specific type of Medicaid for women handles pelvic exams, pregnancy tests, STI services, clinical breast exams, cervical and breast cancer screenings, HIV screenings, contraceptives, screenings related to cholesterol, high blood pressure and diabetes, sterilization services and postpartum depression screenings.

Medicaid for Breast and Cervical Cancer – Under this program, Medicaid services taken care of include emergency care, doctor visits, mental health care, in-home care, prescribed drugs, labs and X-rays, hospital care, pregnancy care, transportation to the doctor, glasses and dental care.

Medicaid for an adult caring for a child – Your Medicaid coverage policy handles vaccines, prescription drugs, doctor visits, X-rays and labs, glasses, dental care, transportation to the doctor and hospital care.

Medicaid Buy-In for Adults – Covered services include prescription drugs, doctor visits, labs and X-rays, hospital care, vision care, dental care, hearing care and community-based services.

Medicaid for Former Foster Care Children – Medicaid services covered encompass all those needs included in both Children’s Medicaid and CHIP, with the exception of dental care for those 20 and younger, only.

Medicaid for Transitioning Foster Care Youth – All the Medicaid services covered by Children’s Medicaid and CHIP also apply to those who need this type of Medicaid policy.

Medicaid for long-term care – The offerings associated with this Medicaid coverage include prescribed drugs, X-rays and labs, doctor visits, hospital care, vision care, hearing care and dental care.

Medicaid for those who receive SSI – Your Medicaid benefits include hospital care, vision care, dental care, hearing care, prescription drugs, doctor visits and labs and X-rays.

What Does Medicaid Not Cover?

It is your responsibility to discuss these circumstances with both your doctor and your Medicaid provider. Those services that are not covered by Medicaid in Texas will have a price tag attached. And, it is your responsibility to take care of those Medicaid cost estimates.

If you cannot pay for uncovered Medicaid services, speak to your medical contacts to estimate Medicaid costs for a payment plan, instead. For more information about the services that are covered and those that are not, download our helpful guide.

How Much Does Medicaid Cost in Texas?

How much is Medicaid in TX? Now that you understand the types of Medicaid insurance offered and the associated Medicaid services covered, note that your costs will remain low. Some Medicaid coverage plans in Texas are associated with costs.

A child who needs Medicaid coverage can expect to pay no more than $50 per year under the Texas CHIP policy.

When you plan to take part in the Medicaid Buy-In for Children or the Medicaid Buy-In for Adults, you are required to make monthly payments depending on your income and your household size.

If you receive Supplemental Security Income and want to obtain Medicaid coverage, you may be required to pay partial costs out-of-pocket, excluding what is needed for medical-related costs and your personal needs. This code also applies to those interested in receiving Medicaid for long-term care.

How much is Medicaid in terms of all other policies? So long as you remain within the income limits according to your household size, the services defined in this section are of no cost to you through Texas Medicaid coverage.