Medicaid Costs and Coverage in Maryland

The question, “How much is Medicaid in Maryland?” is a common concern for many state residents reviewing the application process for health insurance. In order to fully understand Medicaid cost estimates, you must first understand what coverage benefits will be available to you in order to avoid out of pocket fees. When you are approved for Medicaid, you are typically eligible for the Managed Care Organization (MCO) from Maryland HealthChoice. The plan you sign up for will greatly affect your coverage costs. Therefore, it is crucial that you understand the types of Medicaid insurance in order to make the choice that is right for you. To learn more about Medicaid coverage options in Maryland and cost estimates, you can review the sections provided below for more details.

Types of Medicaid Insurance in Maryland

In order to determine how much Medicaid is, you must first know what benefits are available with each Medicaid Managed Care Organization (MCO) to ensure that you choose the right MCO for you and avoid out-of-pocket charges. Medicaid cost estimates depend on your ability to stay within the medical services that are available to you through the Medicaid program. Should you fail to select an MCO in a timely manner, the state of Maryland will choose one for you. Other than when you initially obtain Medicaid benefits, you will only be eligible to change your MCO when it is time to renew your benefits. The answer to the question, “How much does Medicaid cost?” can depend on your Medicaid eligibility for the MCO plan. Besides the MCO Medicaid coverage option, you may only receive standard Medicaid if you do not qualify for an MCO, although most applicants will receive MCO services.

What services are covered by Medicaid in Maryland?

Medicaid cost estimates in Maryland rely heavily upon the MCO that you choose, as your MCO will determine any copayments you may receive or the out of pocket costs you could incur. When choosing the type of Medicaid insurance that is right for you, you should consider which MCO provider would provide medical services in your area. You should also determine which MCO would include your preferred doctors, specialists, pharmacies and hospitals. When weighing how much Medicaid is for your household, you should consider the services and benefits does each MCO have to offer.

The Medicaid coverage that each MCO provides changes what pharmacies, doctors and specialists are available to you. If you have a primary care provider or pharmacy that you prefer, it is important to choose an MCO that will provide you the benefits that you need. When considering what services are covered by Medicaid, it is important to know that there are medical services that are provided by each MCO, including:

  • Visits to the doctor, including regular checkups and preventative services.
  • X-ray and laboratory services.
  • Emergency services (even if you are traveling outside of Maryland), urgent care services and hospital services.
  • Prescription drug coverage.
  • Family planning and birth control services.

Pregnant beneficiaries are also eligible to receive services related to the pregnancy, including prenatal and postpartum care. Children more Medicaid coverage than an adult in terms of vision and dental services, but some vision and dental insurance is available to adults. While all MCOs allow at least one vision exam and a pair of glasses, some MCOs go a step further with offering additional maximum benefits and even contact lenses. When it comes to dental services, adults are eligible to receive at least one oral exam, two cleanings and X-rays once each year. Dental Medicaid coverage is widely different between MCOs, but most MCOs will provide coverage for filings and extractions. To learn what services are covered by Medicaid, you can download our national Medicaid guide today for more information.

Maryland Medicaid Coverage for Medicare Beneficiaries

When asking, “How much is Medicaid in Maryland?” it is important to know of the additional benefits that are available to Medicare beneficiaries who meet eligibility requirements. If you are currently receiving Medicare health insurance, Maryland Medicaid may be able to help you pay for some of the costs towards your Medicare premiums, copayments, coinsurances and deductible amounts. If you are eligible for both Medicaid and Medicare, you can have dual eligibility. In cases such as these, your Medicaid will provide coverage where Medicare does not.

Maryland Medicaid Coverage for Transportation Services

When considering what services are covered by Medicaid in Maryland, it is important to know that Medicaid also provides transportation services to and from visits with physicians and specialists. These services can be arranged through your local health department. Some MCOs offer additional transportation services such as taxis, van services and bus tokens. In most cases, you will not be eligible for Medicaid coverage in regards to transportation services if you have a working vehicle. If you own a vehicle, but it is not currently in working order, you may need a letter from your mechanic stating that your vehicle is nonfunctional. If you are unable to drive, you may need to present a letter from your physician stating such.

What does Medicaid not cover in Maryland?

Medicaid coverage in Maryland varies with each Managed Care Organization (MCO), but there are some medical services that are never covered under the Maryland state Medicaid program. For example, experimental and cosmetic surgeries and procedures are never provided coverage. Some surgeries will also require a prior authorization from your treating physician in order to receive coverage. There are varieties of medications that do not receive Medicaid coverage, and should you need one of those medications, you should ask your doctor if there is a generic version of the medication that may be covered or if another medication may work just as well. HealthChoice MCO through Medicaid does not cover certain groups who may be otherwise eligible for standard Medicaid, such as those receiving Medicare or those who receive Medicaid eligibility through a spenddown. Before determining Medicaid costs estimates, you must make sure of your eligibility for each program type during the application process.

How much does Medicaid cost in Maryland?

As stated previously, Medicaid cost estimates in Maryland will rely upon whether or not you remain within your coverage and benefit limits. If you receive a medical service that is outside of your Medicaid coverage benefits, you will have to pay the full cost of the service that you received. Additionally, some services, such as dental and vision services, have a maximum benefit amount per calendar year. Should you incur more charges than that benefit amount, you will be expected to pay the difference for those medical services. While Medicaid cost estimates in Maryland do not include monthly premiums, with the exception of the Children’s Health Insurance Program (CHIP), some medical services will include minimal copayments. Copayments are most commonly requested when obtaining prescription drugs from a pharmacy, but the amount of your copayment will vary depending on your MCO. To learn more about coverage for Medicaid, you can download our comprehensive national Medicaid guide now.