Medicaid Costs and Coverage in Illinois

“How much is Medicaid in Illinois?” is a question that many state residents may have. Knowing the answer to “How much does Medicaid cost?” is critical before you apply to receive Medicaid assistance, so that you can ensure that you are able to afford the potential monthly payments. Medicaid cost estimates can be obtained in order to show you the range of what you may need to pay if you meet Medicaid eligibility requirements. Furthermore, it is beneficial to also know what services are covered by Medicaid so that you can ensure that the Illinois medical assistance program is a good fit for you and your household and the specific medical issues that you have. There are certain services that Medicaid does not cover, and understanding what those are ahead of time can lead to less confusion and potential problems in the future. To gain a better understanding of how much Medicaid costs in Illinois and the services that are covered by these health benefits, read the sections below.

How much does Medicaid cost in Illinois?

A common question is, “How much is Medicaid?” This question is important because understanding how much Medicaid costs can allow an applicant to make an educated decision about whether or not he or she wishes to apply for Medicaid assistance in Illinois. There are certain situations where the income of an individual or household is low enough to qualify for healthcare costs completely covered by the Medicaid program in Illinois.

Medicaid cost estimates can provide a good range of the costs that could potentially be required for beneficiaries to pay in order to receive this health coverage. Only estimates for Medicaid costs can be provided because the actual amount of money that a household must pay to receive Medicaid each month can vary. This variation in how much Medicaid costs depends heavily on the monthly income of the household. Households that bring in a higher monthly income will be required to pay a higher monthly payment, which is also referred to as a monthly premium. It is very important to have a good understanding one’s household income as it determines the amount of money the beneficiaries must pay in monthly premiums.

In addition to how much Medicaid monthly costs are, beneficiaries must also understand that depending on their specific coverage plan, they may need to pay a deductible or coinsurance. How much Medicaid pays varies as certain plans only cover a percentage of the medical costs, so it is the responsibility of the beneficiary to pay the remaining amount of the bill when it is due. You will not know exactly what your monthly premium payments will be or what percentage of your medical bills will be covered by Medicaid until you complete the application procedure, so it is important to officially apply in order to gain the most legitimate information.

What services are covered by Medicaid in Illinois?

It is important to understand the types of Medicaid insurance services before you apply for Medicaid benefits or seek non-emergency medical care in order to ensure that the Illinois Medicaid program is right for you. Medicaid coverage will vary depending on the specific Medicaid program that you are enrolled in, although there are certain services that are covered by all of the Medicaid assistance programs in Illinois. There primary services include long-term, hospital and physician care. The types of Medicaid insurance you have will determine whether services are either completely or partially paid for.

For more details on the services that Medicaid covers, download our comprehensive guide.

Many services covered by Medicaid are part of the federal government’s mandatory coverage regulations. While many Medicaid services are determined by the state of Illinois, there are certain medical services that every state must provide Medicaid beneficiaries. These mandatory benefits include, but are not limited to:

  • Nursing facility and home health services.
  • Rural health clinic services.
  • Nurse Midwife services.
  • Family planning services.
  • Transportation to medical care.
  • EPSDT (Early and Periodic Screening, Diagnostic and Treatment Services).
  • Services at federally qualified health centers.

In addition to the mandatory services that are covered by IL Medicaid, there are also services that the state of Illinois has decided to cover. Access to these additional services depends on the specific program in which a beneficiary is enrolled and usually include prescription medications, certain medical equipment and transportation, dental services for children, x-rays and other medical services. However, it is crucial to understand the answer to the question, “What does Medicaid not cover?” as well, so that you can avoid having to pay out-of-pocket expenses for services that Medicaid will not pay for.

What Does Medicaid Not Cover in Illinois?

There are services that Medicaid does not cover in Illinois that are important for all beneficiaries and potential applicants to be aware of. For example, while Medicaid coverage is provided for dental services for children who are 18 years of age or younger through the All Kids program, regular dental services are not covered for adults. However, emergency dental services are covered by Medicaid in Illinois. In the case of a dental emergency for an adult, covered services will include the exam, any necessary x-rays, and sedation. Though those services are only covered if an extraction is completed on the same day as those services or within at least seven days.

Also, Medicaid does not cover certain drugs in Illinois. For example, drugs not covered by IL Medicaid include fertility drugs, drugs for cosmetic purposes or hair growth, and weight loss and weight gain drugs. Furthermore, it is important to note that certain services that are not considered medically necessary will not be covered by Medicaid.

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