Medicaid Costs and Coverage in Kentucky

You may be wondering, “How much is Medicaid in Kentucky?” which is a valid question. Knowing the answer to “How much does Medicaid cost in KY?” can help you with planning a household budget and become prepared for facing the costs of healthcare through this program. Medicaid cost estimates are generally the same for each beneficiary and include copayments at the time of service. However, there are some individuals who will not be expected to make a copayment for Medicaid benefits. Costs are also dependent on the type of Medicaid program you are enrolled in, as well as the Medicaid insurance provider. It is recommended that you familiarize yourself with what services are covered by Medicaid in order to avoid out of pocket fees. For more information on the coverage and costs of the Medicaid program, continue reading the sections below. You will also find information on prior authorizations, transportation services and services that Medicaid does not cover.

The Types of Medicaid Insurance in Kentucky

One important factor in determining the cost of Medicaid in Kentucky involves the Managed Care Organization (MCO) that you select when you complete the Medicaid application process. While these types of Medicaid insurance contain the same levels of medical coverage, each MCO has its own doctors and locations that are approved for Medicaid benefits. In order to avoid unexpected Medicaid out-of-pocket costs, it is recommended that you review each MCO carefully upon your approval for enrollment in order to choose a MCO that has a contract with your family care provider. In addition to the variation of providers, MCOs may also have a slight variation for the copayments expected when receiving medical services.

You can select the Medicaid coverage that you would like to receive when you are first approved for the Kentucky Medicaid program. Should you like to change your MCO, you may do so within the first 90 days of coverage. Should you miss the 90 day window, you will need to wait until the following year to select a different provider.

How Much Does Medicaid Cost in Kentucky?

When considering how much Medicaid costs in Kentucky, it is important to factor in the amount that you may be expected to pay for copayments. Copayments for covered services can be anywhere between $0 and $60, depending on the service that is provided and the MCO that you have chosen. However, when considering Medicaid cost estimates, it is important to know that the maximum amount of copays cannot exceed 5 percent of a family’s total income per calendar quarter.

Some individuals are exempt from receiving a Medicaid coverage copayment, including:

  • Children who are under the age of 18 years old.
  • Pregnant women.
  • Individuals who are institutionalized in a long-term care facility, medical institution or are currently an inpatient in a hospital.
  • American Indians.
  • Individuals receiving hospice care.

Additionally, some Medicaid coverage services do not require copayments, such as family planning, emergency services and preventive services.

What services are covered by Medicaid in Kentucky?

Medicaid costs in Kentucky are not the only factors you should consider when it comes to the Medicaid program. It is equally important to be aware of what services are covered by Medicaid in order to ensure that you do not receive out of pocket costs for non-covered services. Kentucky Medicaid provides coverage for a number of medical services including hospital stays, transplants, emergency room visits, emergency ambulance usage, office visits with a physician, radiation therapy, family planning services, chiropractic services, prosthetic devices and physical, occupational and speed therapy. Services that are covered by Medicaid will also include prenatal and maternity services for pregnant women.

Children receive a greater Medicaid coverage than adults, especially in terms of dental, hearing and vision care. Children are eligible to receive dental services, vision services and hearing services as needed. They are also able to receive hearing aids through the Medicaid program. Adults do not receive hearing services, but can receive one eye examination, one dental cleaning and one set of dental x-rays in a one-year period. Medicaid coverage for prescription drugs is available, but there are different copayments for generic, preferred brands and non-preferred brands.

All Medicaid benefits and services must be deemed medically necessary in order to receive coverage.

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

Obtaining Prior Authorization for Kentucky Medicaid

Now that you have a better understand of what services are covered by Medicaid in Kentucky, it is important to know that many services require prior authorizations. Your primary care provider (PCP) will request prior authorization from Medicaid on your behalf. Some services that require prior authorization include transplants, inpatient rehabilitation, inpatient psychiatric services, sterilizations, private duty nursing, some dental services, durable medical equipment and supplies and speech therapy.

What Does Medicaid Not Cover in Kentucky?

When asking, “How much does Medicaid cost in Kentucky?” it is important to be aware of services that are not covered by the Medicaid program, regardless of whether you meet eligibility requirements. If Kentucky Medicaid does not offer coverage for a medical procedure that you have, you will have to pay the full cost of the procedure yourself. Most services not deemed medically necessary will not receive coverage through Medicaid. These can include cosmetic surgery and massage therapy

Kentucky Medicaid Coverage Regarding Transportation Services

Kentucky Medicaid coverage also includes transportation services that provide rides to and from doctor appointments, however it is vital that you understand the requirements for transportation services. Transportation services will only be available to you do not have a vehicle or are unable to drive. In cases where you are unable to drive, for Medicaid coverage to take effect, you will need to provide:

  • A note from your physician that states you are unable to drive.
  • A note from your mechanic that states your car will not run.
  • A note from a supervisor or school official that states the car is needed for someone else’s work or school.
  • A copy of your vehicle’s registration is the car has been junked.

It is also worth noting that Medicaid does not cover transportation to pick up a prescription.

Download our comprehensive guide for more details on the costs and covered services of the Medicaid program.