Medicaid Costs and Coverage in Alabama

“How much is Medicaid?” is one of the most frequent questions that applicants to the Alabama state Medicaid program ask. This question is followed by, “How much does Medicaid cost for each of the state’s Medicaid sub-programs?” Medicaid cost estimates can be provided for each sub-program, as determined by the agency which oversees that Medicaid program. To understand Medicaid costs in Alabama, applicants must understand that there are several types of Medicaid programs serving the needy throughout the state. There are three different agencies that help determine what services are covered by Medicaid for each sub-group: The Social Security Administration, The Department of Human Resources and The Alabama Medicaid Agency. The different types of Medicaid insurance programs available in Alabama provide various levels of coverage. It is also important to know that there are certain services that Medicaid does not cover. Keep reading the sections below to learn more about the costs of Medicaid in Alabama and the services that are covered by this program.

How Much is Medicaid in Alabama?

As previously mentioned, how much Medicaid costs in Alabama depends on the Medicaid sub-program for which the claimant is completing the application process. For many applicants, AL Medicaid cost estimates are zero because their sub-program offers complete Medicaid health coverage. Applicants should receive complete Medicaid coverage without having to make any co-payments if they are in a nursing home, under the age of 18, receiving pregnancy-related or family planning services or are eligible Native American citizens. Medicaid costs may include a small co-payment by the recipient who meets eligibility requirements for some medical services. In most cases, the estimated Medicaid costs for the recipient will be no more than a few dollars for each of the following categories of medical services: general doctor visits, optometric (eye care) services, certified nurse practitioner visits, health care center visits, rural health clinic visits, inpatient hospital (for each admission), outpatient hospital (for each visit), ambulatory surgical centers, prescription drugs, and medical equipment, supplies and appliances. How much a Medicaid co-payment is will increase if the recipient goes to the emergency room or visits an out-of-state doctor not enrolled in the Alabama Medicaid scheme. Regardless of what type of Medicaid insurance a recipient has, he or she cannot be asked to pay more than the co-payment for any medical services rendered that are covered by Medicaid.

Some services completely covered by Medicaid in Alabama never require a co-payment from program participants. These Medicaid covered services include the following:

  • Birth control or family planning services
  • Physical therapy in an outpatient hospital
  • Chemotherapy or radiation treatment
  • Dental services for children under 21 years of age
  • Home mental health and substance abuse treatment services
  • Case management services and preventive health education services
  • Home and community services for people who are intellectually disabled, or the elderly and physically disabled

What Services Are Covered by Medicaid in Alabama?

What services are covered by Medicaid in each Medicaid sub-program are determined by the three Alabama state agencies mentioned above. Some of the primary benefits included with every type of Medicaid insurance for all program recipients include:

Medicaid Coverage for General Medical Services

  • Doctor Services: Alabama Medicaid coverage includes several doctor visits every year and multiple days of a doctor’s care in the hospital. Coverage in Alabama also includes at-home doctor visits in certain situations, like when the Medicaid recipient’s illness, injury or disability prevents him or her from easily leaving their home. How much Medicaid costs are for out-of-state medical services varies by situation and may or may not be covered by the program.
  • Hospital Services (Inpatient and Outpatient Hospital Care): The services that are covered by Medicaid include unlimited days in the hospital and unlimited outpatient visits as deemed medically necessary by the doctor, in addition to a few outpatient surgical procedures. Laboratory and X-ray services are also covered when medically required.
  • Mental Health Services: All types of Medicaid insurance programs include Medicaid coverage for benefit recipients diagnosed with a mental illness or substance abuse problem.
  • Prescription Drugs: Alabama Medicaid coverage includes most prescription drugs prescribed by a recipient’s doctor, unless the drug must receive special approval from the Medicaid agency first.
  • Eye Care Services (for adults): The services that are covered by Medicaid in limited number of eye exams every year.

For more information on services that are covered by Medicaid, download our comprehensive guide.

Medicaid Coverage for Women, Children and Family Services

  • Maternity Services: Coverage for maternity services aims to support the health of the mother and the baby throughout the entire pregnancy and thereafter. The maternity services covered by Medicaid include prenatal care, delivery and postpartum care along with nurse midwife services related to maternity care, delivery and routine gynecology services.
  • Family Planning Services: Regardless of what type of Medicaid insurance a recipient has, he or she can receive unlimited family planning care.
  • Services for Children: Benefit recipients under the age of 21 with coverage in Alabama are entitled to yearly dentist visits, eye care services and hearing services to maintain good health. All types of Medicaid insurance for children in Alabama also completely cover psychiatric hospital services as prescribed by the doctor.
  • Well Child Checkup Program (EPSDT): This program extends coverage for recipients under the age of 21 to include more doctor visits and services is a problem is found during screening.

Medicaid Coverage for the Elderly

  • Hospice Services: If a Medicaid benefits recipient is terminally ill with a relatively short life expectancy, Alabama Medicaid coverage includes fees for hospice care and relating to hospice care, such as necessary medicines and therapies.
  • Psychiatric Hospital Services: Services that are covered include necessary psychiatric services or hospital care for recipients over the age of 65.
  • Nursing Home Care Services: Applicants with full Medicaid coverage will have all nursing home feeds paid, including those relating to room and board, medication and doctor visits.

What Does Medicaid Not Cover in Alabama?

Alabama Medicaid does not cover what medical treatments or supplies that are deemed not medically necessary, such as the following services:

  • Cosmetic surgery or procedures
  • Hospital meal trays or cots for guests, TV and VCR/DVD in-room rentals or sitter services
  • Infertility services or treatment
  • Experimental treatments, drugs or supplies
  • Hearing services and dental services for most Medicaid recipients aged 21 or older, including routine orthodontic care like crowns or braces
  • Respiratory therapy, speech therapy or occupational therapy for benefit recipients over the age of 21

Download our comprehensive guide for more information on the costs and coverage of Medicaid.