Medicaid Costs and Coverage in Hawaii

Many residents wonder, “How much is Medicaid in Hawaii?” and they may not know about the many different coverage options that are available in the state. Discovering what services are covered by Medicaid can lead to a better understanding of the level of benefits that you may be able to receive, as well as how much you could need to pay. Medicaid cost estimates vary widely, but they are crucial in getting a better picture of how much you will need to spend on healthcare every month. This article will discuss how to answer the question, “How much does Medicaid cost in Hawaii?” and go through the many Medicaid covered services that you can utilize for little to no cost.

Download our comprehensive guide to affordable health care to learn more about the costs and qualifications of Medicaid.

Medicaid Cost Estimates in Hawaii

You should get Medicaid coverage in Hawaii if you do not have health insurance and are struggling to pay your medical bills, or if your current health insurance costs are too high. This is because Medicaid insurance coverage was designed to benefit low-income Hawaiians who need help – so Medicaid costs should not be overly expensive, if they exist at all. In fact, many Medicaid cost estimates do not have any copays or premiums at all, depending on the type of service that you want covered. But, sometimes, Medicaid benefits cannot cover certain services without requiring a small amount of these costs to be covered by the applicant.

The state’s two Medicaid coverage providers, Hawaii QUEST (Med-QUEST Division, or MQD), and the Hawaii Medicaid Fee-For-Service (FFS) are responsible for establishing the Medicaid costs and coverage options for all Hawaiians. Additionally, children can get Medicaid coverage in Hawaii through the Children’s Health Insurance Program (CHIP) – this is operated through MQD, but applies only to children younger than 18 years of age.

Whereas MQD provides Medicaid coverage for Hawaiians younger than 65 years old who are also not blind or disabled, FFS is responsible for covering Hawaiians who are older than 65 years old, but are also blind or disabled. They also regulate Medicaid insurance eligibility and application information in the state – therefore, making sure that you meet all of the prerequisites to receive coverage is critical when trying to determine how much you will need to pay. Hawaiian Medicaid cost estimates rely fairly heavily on whether or not you exceed the MQD and FFS household income level percentage. If you are making too much in annual household income, you may be ineligible to receive any benefits whatsoever. Because these Medicaid coverage income limits change every year due to federal health care’s price fluctuations, it is often best to confirm your income-based eligibility with MQD/FFS directly.

What services are covered by Medicaid in Hawaii?

Learning about the different types of Medicaid insurance in Hawaii is the best way to come to a conclusion as to which kinds of coverage plans you need. You will receive a letter in the mail detailing what services are covered by Medicaid in your Hawaii coverage plan – however, the majority of them will have to do with covering some of your most basic medical costs. Some of the most widely distributed Medicaid insurance benefits are involving doctor visits, inpatient and outpatient hospital visits, medical transportation services and prescription drug costs. Those with FFS Medicaid coverage also get dental care included – otherwise, MQD coverage has dental care provisions for anyone younger than 21 years of age.

Some other Medicaid covered services that Hawaiians can be eligible for are dialysis, provision of durable medical equipment (such as crutches, walkers, etc.), rehabilitation services, radiology services, hospice services, mental health services and many more. Different types of Medicaid insurance are beneficial for different residents of Hawaii – you can contact MQD or FFS if there are specific medical services that you would like to ensure are covered. Your specific Medicaid coverage options will be outlined in the initial letter from your Hawaii MQD/FFS provider.

Additionally, CHIP Medicaid benefits for Hawaiian children operate in a similar way to normal MQD benefits – however, they also cater to child-specific services. This Medicaid coverage plan allows children to receive financial aid for their routine pediatric care check-ups, immunization appointments, and dental care.

What does Medicaid not cover in Hawaii?

Even with the best MQD/FFS Medicaid insurance coverage plan Hawaii residents may not be able to have all of their medical needs run through Medicaid. As previously mentioned, some types of Medicaid insurance, like FFS with dental coverage, cover more things than others. But on top of that, there are other services that Medicaid does not cover, including those that are not medically necessary. These could be such non-Medicaid qualifying services as cosmetic surgery, family member-provided healthcare, etc.

Certain other programs, such as school health services and serious mental illness treatment can be covered by different government agencies, but do not fall under Medicaid. Answering “What does Medicaid not cover in Hawaii?” can be as simple as asking your local MQD or FFS processing center which services they will not permit Medicaid funds to utilize. Additionally, to find out what services are covered by Medicaid, you can contact several different resources. First, you can find out if a service is covered by Medicaid in Hawaii by contacting the doctor or specialist that is providing said service. You can also contact your local Medicaid office if you still have questions regarding a particular service or medical equipment.

Hawaii Medicaid Coverage & Cost Factors to Consider

When you do need to determine how much Medicaid is in Hawaii for your monthly costs, you can rest assured that they will never be too high for your income bracket. The Hawaiian government, including MQD and FFS are aware of Medicaid recipients’ financial situations, so they will not require you to pay more than you are able – after all, they want to help you to manage your medical bills with your low income. If your Medicaid coverage requires you to pay a monthly premium or deductible, it will be a very low one in order to help cover the higher-than-average costs of hospital visits, surgeries, prescription drugs and more.

But in many situations, your Medicaid insurance benefits may be able to cover up to 100 percent of your medical bill. Pairing Medicaid coverage with Medicare or a private health care service is the best way to ensure that you can get the medical services that you need, for a reasonable (or even completely free) price. As a Hawaiian Medicaid recipient, it is critical that you ask MQD//FFS about any associated costs that you may need to know about and prepare for when you apply for their coverage.

Download our guide to Medicaid to learn more about the costs and coverage you qualify to receive, based on income, age and other key factors.