Medicaid Costs and Coverage in Louisiana

You may be wondering, “How much is Medicaid in Louisiana?” which is a valid question. Medicaid cost estimates will heavily rely upon which medical services and prescription drugs a Medicaid recipient receives. It is important to familiarize yourself with Medicaid coverage guidelines in order to avoid out-of-pocket costs. You should also become aware of the copayments that you may be expected to pay when receiving medical services. For more information on what services are covered by Medicaid in Louisiana, review the sections provided below.

The Types of Medicaid Insurance in Louisiana

As part of knowing how much is Medicaid in Louisiana, it is recommended that you familiarize yourself with Louisiana Medicaid Managed Care Organizations (MCOs). MCOs provide Medicaid coverage and additional services such as transportation services on behalf of the state of Louisiana. When you are first enrolled in Louisiana Medicaid, you may be provided with several MCOs that you may choose from. Information about Medicaid insurance types, such as the services covered by Medicaid, is valuable for first-time beneficiaries selecting an MCO. While a Managed Care Organization does not affect your Medicaid coverage benefits, it may affect which doctors or medical service locations are covered under your Medicaid benefits. Additionally, copayments can vary by MCO. It is important to review each MCO upon your initial acceptance into the Louisiana Medicaid program in order to choose the provider that will work best for you and your family. You may only change your MCO for a short period of time after first being enrolled in Louisiana Medicaid and then annually.

How much does Medicaid cost in Louisiana?

Louisiana Medicaid cost estimates vary from beneficiary to beneficiary. Estimating how much is Medicaid is not a straightforward answer. Some individuals and families will receive a copayment requirement with select medical services. The exception to the copayment rule comes in the form of children who are not required to provide copayments upon receiving services. Additionally, it is important to familiarize yourself with Medicaid coverage as any service, procedure or prescription drug that is received and not covered by Medicaid will impose out-of-pocket fees for the entire amount of the service. Despite Louisiana Medicaid copayments, Medicaid is still considered a very affordable health insurance program. Download our comprehensive Medicaid guide to learn more about the program and its benefits.

What services are covered by Medicaid in Louisiana?

It is crucial that you know what services are covered by Medicaid in Louisiana in order to avoid out-of-pocket costs. Medicaid coverage includes general medical services such as the following:

  • Visits with a physician
  • Behavior health services
  • Preventative services
  • Family planning services
  • Laboratory and X-ray services

In addition to these common services, Louisiana Medicaid offers coverage for chiropractic services, chemotherapy, speech therapy, physical therapy, hospital services, immunizations, hospice and some durable medical equipment. However, it is important to understand that the Medicaid eligibility group you belong to will affect which services are covered by Medicaid and which are not. When it comes to vision benefits, for instance, children who are 21 years of age or younger may receive examinations, vision treatment and eyeglasses that meet minimum strength requirements. Contact lenses are also covered, so long as they are the only means for restoring vision. Adults who are older than 21 years of age will receive examinations and treatments for eye conditions, such as infection or cataracts. Medicaid coverage provides dental services to children who are 21 years of age or younger including the following:

  • Preventative dental care
  • Restorative dental care
  • Oral and maxillofacial surgery
  • Orthodontic services

When considering Medicaid cost estimates in Louisiana, it is important to consider the additional coverage benefits that Medicaid has to offer. Most beneficiaries with Medicaid coverage will have access to transportation services as part of their coverage, no matter which MCO is chosen during enrollment. Medicaid coverage concerning transportation services is available to patients to assist them in getting to and from their scheduled medical appointments. In most cases, Medicaid information pertaining to transportation will need to be requested 48 hours prior to a medical appointment at a minimum. Occasionally, same-day transportation scheduling may be available when medically necessary. While transportation is available to all eligible Medicaid beneficiaries, children who are younger than 17 years of age will need to be accompanied by an adult.

Senior citizens who receive both Louisiana Medicare and Medicaid coverage are considered dually eligible and may receive additional benefits that can provide coverage to medical services that are not covered by Medicare. In some cases, Louisiana Medicaid coverage may include helping pay for Medicare premiums, deductibles, co-insurance and copayments. Dually-eligible beneficiaries will be able to discover their qualifications for benefits during the Medicaid application process or when signing up for Medicare.

Louisiana Medicaid Prior Authorization

When considering how much Medicaid is in Louisiana, it is important to familiarize yourself with prior authorization requirements in order to avoid out-of-pocket fees. Doctors and pharmacists prior to most surgical procedures, several prescription drugs and many medical procedures prior to the medication or medical services becoming available to you seek prior authorization for Medicaid coverage. If a service is covered by Medicaid requires prior authorization and that authorization is not requested, you will likely be responsible for the entire cost of the medical procedure or prescription drug. However, prior authorization for Medicaid coverage may be waived in emergency situations. For more information on Medicaid coverage, download our detailed Medicaid guide here.

What does Medicaid not cover in Louisiana?

If you are asking, “How much does Medicaid cost in Louisiana?” then it is recommended that you familiarize yourself with the services that Medicaid does not cover in Louisiana. This can help you to avoid surprising out-of-pocket costs. While Louisiana’s Medicaid coverage is quite expansive, it does not cover every medical procedure or prescription drug. In fact, there is an extensive range of prescription drugs that are not eligible for coverage under Louisiana Medicaid. In cases such as these, it is recommended that you talk with your doctor about off-brand versions of the prescription drug that has been recommended to you or if another prescription that is covered by Medicaid may work equally well.

Additionally, Medicaid coverage will not be extended to any medical service that requires prior authorization, in which authorization is not requested. Exceptions are generally applied in the event of an emergency where there is not time to obtain prior authorization. Louisiana Medicaid does not cover surgeries and procedures that are considered cosmetic. Some fertility procedures and drug therapies are also excluded from coverage.