Medicaid Costs and Coverage in Alaska

“How much is Medicaid in Alaska?” is a question many residents may ask themselves. Welfare candidates in Alaska interested in knowing Medicaid cost estimates for state residents must first familiarize themselves with the Alaska Medicaid scheme to find out which Medicaid program the applicant meets eligibility requirements for. How much does Medicaid cost for the various sub-programs offered in Alaska? Once a Medicaid program is chosen, a potential Medicaid candidate can establish his or her annual costs. Each specific program also dictates what services are covered by Medicaid for participants and how they can receive such services. Keep in mind that there are some services that Medicaid does not cover. Additionally, some types of Medicaid include additional medical services not generally covered by all Medicaid programs. Keep reading to learn more about what is included in Alaska Medicaid coverage and what you can expect your costs to be.

How Much Does Medicaid Cost in Alaska?

The cost of Medicaid in Alaska depends on the Medicaid program for which an individual completes the Medicaid application process. Medicaid coverage in AK for candidates in any of the following categories involves no cost to the recipient: children under the age 18, pregnant women, seniors in nursing homes or hospice care, family planning services and supplies, emergency services and Chronic & Acute Medical Assistance (CAMA) recipients. Other types of Medicaid insurance than those mentioned above require benefit recipients to pay a copayment for most services received. This copayment varies by medical service provided and is paid directly to the healthcare provider at the time of service. If a recipient cannot make the necessary payment at the time of service, the healthcare provider will still provide aid and will bill the recipient for charges due.

Regardless of what services are covered by Medicaid, the Medicaid recipient may be denied future service at a previous healthcare provider if he or she does not pay copayment bills that are owed to that provider. Medicaid cost estimates for copayments vary by service and can range significantly in price. For example, most Medicaid coverage recipients will be asked to pay a copayment of less than a dollar for some prescription medications, $50 a day for inpatient hospital care and a certain percentage of the allowed amount for outpatient hospital services other than emergency services. All types of Medicaid insurance in Alaska allow for benefit recipients to receive medical services out-of-state at providers enrolled in the Alaska Medicaid network. Out-of-state healthcare providers who are not enrolled in any of the Alaska Medicaid coverage options have the option to enroll in the program to receive payment within one year of providing medical service to an eligible Medicaid recipient. If an out-of-state healthcare provider refuses to enroll in the Alaska Medicaid program, a participant’s Medicaid coverage will not pay for any services rendered by that provider and instead all financial obligation will fall to the participant.

What Services Are Covered by Medicaid in Alaska?

The medical services included in Medicaid coverage in Alaska are determined by the Department of Health and Social Services (DHSS) and its internal Division of Public Assistance (DPA). Alaska Medicaid healthcare coverage is divided into several categories according to the services and treatments provided to a benefits recipient. Here are some examples of what services are covered by Medicaid in Alaska and for all benefits recipients and for certain categories of recipients:

Medicaid Coverage for General Medical Services

  • Emergency Care: All types of Medicaid insurance in Alaska cover emergency medical services in the case of a sudden, unexpected medical situation.
  • Physicians and Advanced Nurse Practitioners (ANP): Adults with Medicaid coverage who receive a medically-necessary service from a physician or an advanced nurse practitioner are covered. Children with Medicaid coverage also receive complete doctor and ANP care in addition to preventative services like screenings and immunizations.
  • Surgery: Included in all types of Medicaid insurance are funds for medically necessary surgery performed in a hospital or outpatient clinic for adults and children.
  • Dental Services: One of the services covered by Medicaid in Alaska is the treatment of dental pain or acute infection in adults, in addition to an additional sum for enhanced dental services. Children receive complete dental Medicaid coverage, including exams, x-rays, polishing, orthodontia care and more.
  • Medical Equipment and Supplies: Medicaid cost estimates include all equipment or supplies deemed necessary by the recipient’s healthcare provider, including prosthetic devices and home infusion therapy.
  • Personal Care Assistant (PCS) Services: Medicaid coverage in Alaska includes PCA services to help benefits recipients with activities of daily living (ADLs), like bathing or dressing, or instrumental activities of daily living (IADLs) such as grocery shopping and housekeeping.

For more details on what Medicaid covers and the associated costs of this program, download our comprehensive guide.

Medicaid Coverage for Specific Groups of Benefit Recipients

  • Breast and Cervical Cancer Checkups: Covered Medicaid recipients can receive mammograms or breast X-rays as needed and ordered by a healthcare provider.
  • Community Behavioral Health Services: How much Medicaid is for behavioral health services depends on the specific services provided, though most mental health and substance abuse treatments are included for both children and adults.
  • Inpatient Psychiatric Hospital and Residential Psychiatric Treatment Services: For Medicaid coverage to kick in, a benefits recipient in Alaska must receive a service authorization from a healthcare provider for all psychiatric admissions and sojourns at both in-state and out-of-state medical centers. Medicaid cost estimates for these services will vary significantly by the age of the benefits recipient.
  • Home and community-based waivers (HCBW): The HCBW program provides integrated Medicaid coverage in the home and community for adults or children that require the help of a full-time caretaker due to age, ailment or severe mental or physical disability. Covered Medicaid services include delivered meals, respite for the primary caretaker, specialized medical equipment, supported employment and more.
  • Pregnancy and Postpartum Care: A special type of Medicaid insurance provides pregnant women with prenatal care checkups and healthcare up until the pregnancy and for at least 60 days after the end of the pregnancy.

What Does Medicaid Not Cover in Alaska?

Medicaid coverage in Alaska does not include all healthcare services for all benefits recipients. Some examples of what Medicaid does not cover in Alaska are: chiropractic services and podiatry services for adults over 21 without Medicare, nutrition services for adults over 21 who are not pregnant, medical services received in another state from a non-enrolled healthcare provider, some hearing and vision services and more.

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