Medicaid Costs and Coverage in Indiana

“How much is Medicaid in Indiana?” is a question that is frequently asked by potential applicants. Medicaid cost estimates can be provided to give applicants an idea of what they may expect to pay. It is important for anyone interested in applying for Medicaid to understand the how much Indiana Medicaid is before beginning the application process in order to be best prepared for what they may need to pay to receive Medicaid health care assistance in Indiana. However, only cost estimates for Medicaid can be provided. Exact numbers cannot be given because each household has different qualifying factors that change the payment amount including the amount of income that the household is producing. “What services are covered by Medicaid?” is another question that must be answered in order for applicants to know if the Medicaid program would work for them and their particular medical history. To learn more about the types of Medicaid insurance and how much Medicaid is in terms of payment amounts in the state of Indiana, read the sections below.

What services are covered by Medicaid in Indiana?

There are many services covered by Medicaid in Indiana, and applicants should investigate the various services to understand what is and is not covered before submitting an application for Medicaid health insurance coverage. Medicaid coverage is provided for a variety of different medical procedures, treatments and other related services, although not every service is covered. Applicants must also be aware that the services Medicaid covers for one household may be different from services covered for a different household. The types of Medicaid insurance vary along with the different Medicaid programs, and that leads to a variety of different coverage options. The following benefits are just a few of the services that are covered by Medicaid in Indiana. Keep in mind that there are additional services not mentioned and many more that may be included in only specific plans:

  • Doctor, wellness and well-child visits
  • Clinic services, lab and x-ray services
  • Hospital care and emergency transportation
  • Mental health care and substance abuse services
  • Dental care, vision care and hospice care
  • Family planning services and chiropractic services

Medicaid coverage is extended to the following medications: prescription drugs approved by the U.S. Food and Drug Administration (FDA), certain over-the-counter (OTC) drugs, smoking-cessation drugs and self-injectable drugs such as insulin. Additionally, supplies such as needles, blood sugar monitors, testing strips and more are available to beneficiaries with conditions that require that equipment for treatment of their disease. Download our Medicaid guide to learn about Medicaid coverage including which health care services must be covered according to federal law.

What does Medicaid not cover in Indiana?

“What does Medicaid not cover?” is an important question to be asked by potential applicants and current beneficiaries since there are certain services that are not covered through the Medicaid program. Although there are many services that Medicaid does cover, there are also benefits that must be paid completely out of pocket if they are provided. Having a good understanding of what is and is not covered by Medicaid before setting up a non-emergency appointment or ordering medications can help save patients a lot of money. It is crucial for beneficiaries to understand that any benefits received that are not covered through Medicaid are the sole financial responsibility of the beneficiary and must be paid in full. Some services covered are based on the provided information on Medicaid applications.

Services that Medicaid does not cover mostly include any service or item that is deemed by the Department of Human Services in Indiana as not medically necessary. A few examples of what Medicaid does not cover includes payment for a private room in a nursing facility or hospital, cosmetic surgery procedures, acupuncture, experimental drugs not approved by the FDA, and certain medications. Medicaid will not pay for these not-covered services in Indiana unless an exception from a physician is provided. Some of the health care items not covered by Medicaid include the following:

  • Medications that are not FDA-approved and/or medically necessary
  • Investigational or experimental medications
  • Fertility or weight-loss medications
  • Cosmetic or hair-growth medications
  • Any over-the-counter medications not on the OTC Drug Formulary list

Although those are medications and services not covered by Medicaid, beneficiaries can still access them if necessary. However, the services must be paid for by the beneficiary in full since they are not considered insured Medicaid benefits. This is the case unless the beneficiary is able to provide documentation and doctor permission for that particular service or item that can be submitted to the Indiana DHS. Download our comprehensive Medicaid guide for more information about requesting Medicaid coverage.

How much is Medicaid in Indiana?

How much does Medicaid cost is mostly dependent on the amount of income the household earns each month. Medicaid coverage and eligibility for Medicaid benefits are both influenced by an applying household’s income. The cost of how much Indiana Medicaid is will be higher for households making a greater amount of money. However, Medicaid coverage is completely free for certain very low-income families or individuals. Understanding the answer to, “How much is Medicaid?” can be very beneficial for households so that they know what they can expect in terms of monthly payments if they are required to make payments at all.

Unfortunately, Medicaid cost estimates cannot be provided to everyone because the amount that a household pays for the Medicaid coverage varies depending on a number of factors, primarily household size and income. For an applicant to discover information about Medicaid costs for his or her household, he or she must complete a Medicaid application to the Indiana DHS.

In addition to monthly payments, there may be copayments required at the time of services or when you purchase particular medications. However, Medicaid coverage prohibits copayments from being required in certain cases in Indiana. For example, copayments cannot be charged for prescriptions for members younger than 18 years of age, prescriptions related to pregnancy, prescriptions administered while in the hospital and more.

The services that are covered by IN Medicaid will be either partially or completely paid for by Medicaid. This depends on the type of Medicaid insurance coverage the household has. In regard to what does Medicaid not cover, the beneficiary must pay for those uncovered services in full. Having a good understanding of those concepts will allow the beneficiary to save money and receive the most benefits out of his or her Medicaid plan.