Medicaid Costs and Coverage in Idaho

How much is Medicaid in Idaho and what services are covered by Medicaid insurance? Information about Medicaid coverage and costs is important for prospective applicants and enrolled beneficiaries alike. Because the Medicaid program is a financial relief program, many health care treatments and preventative services are free for beneficiaries. However, claimants should be aware of the Medicaid cost estimates for the coverage as well as any co-insurance for medical services. Depending on which types of Medicaid insurance residents are eligible to enroll in, health care coverage may include more covered services.

How much does Medicaid cost in Idaho?

The Idaho Department of Health and Welfare (DHW) is responsible for Medicaid coverage and costs as well as the overall Medicaid application process in the state. It determines Medicaid cost estimates in the state and how many Medicaid covered services you may be eligible for based on your qualifications. The primary Medicaid cost estimates that you will receive will be from DHW itself. However, if you are covering your child with Medicaid, then you will be working through the Children’s Health Insurance Program (CHIP). If you are receiving coverage through Medicaid as an elderly adult (older than 65 years of age) or are blind or disabled, then you will be working through the Aid to the Aged, Blind, and Disabled (AABD) program. Once you have applied for Medicaid coverage through DHW, CHIP or AABD, you will receive a letter in the mail detailing what your coverage options are and what you may be expected to pay.

Medicaid covered services in Idaho often have small costs associated with them in the form of copays and premiums. Depending on the types of Medicaid insurance that you utilize and how good your coverage is, you may not need to pay these Medicaid costs at all. It is important to remember that Medicaid coverage is designed for low-income residents, so if you are making more than the annual household income limit that the Idaho DHW sets every year, then you will not meet the Medicaid eligibility requirements to receive any coverage. When you apply for Medicaid coverage through DHW, it will inform you of the most up-to-date income figures that you must earn less than to qualify.

What services are covered by Medicaid in Idaho?

Medicaid covered services in Idaho include those that are medically necessary for your health and well-being. While there are different types of Medicaid insurance plans in Idaho (including the Basic plan, the Enhanced plan and the Medicare-Medicaid Coordinated plan), they all cover what you might expect. Some of these Medicaid coverage options include doctor visits, hospital stays, dental care, prescription drugs and medical-vehicle usage.

Additionally, there are some types of Medicaid insurance that may or may not overlap with your existing health insurance coverage (depending on whether you have Medicare or private health insurance). These coverages for Medicaid include mental health services, hospice care, radiology testing, physical and other types of therapy, pregnancy and family planning services, weight-loss services and many more. If any of these Medicaid covered services do happen to overlap with your Medicare or private health insurance, then their potential costs will decrease dramatically, as your Medicaid coverage will go towards paying your other insurance premiums.

Extended Medicaid coverage is granted to certain at-risk population in Idaho. You may qualify for special Medicaid coverage if you or your dependents are part of any of the following groups:

  • Children younger than 19 years of age
  • Elderly adults 65 years of age and older
  • Blind at any age
  • Disabled at any age

These Idaho Medicaid insurance programs, CHIP and AABD, are in many ways quite similar to the traditional Idaho DHW service but they contain different types of Medicaid insurance coverage. By means of example, CHIP covers some child-specific pediatric services while AABD covers some specialized long-term facilities and hospice care. Download our comprehensive Medicaid guide to learn more about the services covered by the program.

What does Medicaid not cover in Idaho?

Conversely, there are also many health services not covered by Medicaid in Idaho that patients will be responsible for paying. Generally, all state Medicaid coverage programs will refuse to cover services not deemed medically necessary. While some services are deemed “optional” by the U.S. Centers for Medicare and Medicaid Services, that does not necessarily mean that DHW will prevent you from qualifying for them. The state will look at the information on Medicaid applications as well as doctor-suggested treatment options to determine if coverage is needed.

All Medicaid coverage is subject to review, and you should always ask the Idaho DHW if you might be able to receive financial aid for if a certain service you believe that you require. When asking, “What does Medicaid not cover?” the following are the most common services that the program will not pay for:

  • Cosmetic surgery
  • Massage therapy
  • Chiropractic services
  • Home health care that is not sanctioned by a doctor
  • Experimental treatment that is not sanctioned by a doctor

The information on Medicaid applications also determines which services are covered by Medicaid and which are the responsibility of the patient. For instance, children in Idaho will receive more comprehensive Medicaid coverage than their parents or other Medicaid-eligible adults. Medicaid covered services for seniors are also more inclusive if they are also enrolled in Medicare.

Idaho Medicaid Costs and Coverage Considerations

The overall purpose of Medicaid cost estimates is to have Medicaid recipients help pay for the sometimes very expensive medical services that they need. But because you must have a very-low-income level in order to qualify for Medicaid, these costs are designed to also be very low when necessary. Answering, “How much is Medicaid?” is never easy, as different Medicaid services have different amounts to pay in co-insurance and each type of Medicaid insurance cover services differently. The standard and basic plans available in Idaho are designed for adults and children who do not have special needs, while the enhanced and coordinated plans are specifically for residents with special needs. Learn more about the program in our in-depth Medicaid guide.