Medicaid Costs and Coverage in Michigan

“How much does Medicaid cost for me?” and “How much is Medicaid in Michigan?” are questions you may need answered now that your application for Medicaid has been approved. For most beneficiaries to receive Medicaid coverage in MI, they will be required to enroll in a health plan. They may also need to take specific steps to improve their health, such as scheduling a visit with their primary care provider, completing a health risk assessment and also participating in healthy behavior activities. In MI Medicaid cost estimates are given by the health plans, which pay for most of the services. To access your Michigan Medicaid coverage after enrollment with a health plan, you will need both your mihealth card (pronounced “my health”) and your health plan card. The mihealth card does not guarantee that a beneficiary has Medicaid coverage, so your provider will be responsible for checking to make sure you have coverage at each visit. Find answers to questions like, “What services are covered by Medicaid?” and more by reviewing the sections below.

Types of Medicaid Insurancein Michigan

Applicants who qualify for Michigan Medicaid benefits after following the Medicaid application procedures in a health care coverage plan receive a comprehensive package of health care benefits, including dental and mental health services. Medicaid coverage cannot be denied to beneficiaries in the state who have preexisting conditions.

For those beneficiaries who applied for Medicaid health coverage and need to join a health plan, Michigan Enrolls will contact you about the available health plan choices for you and your family. All participants who get coverage for Medicaid in Michigan, with a few limited expectations, must enroll in a Medicaid Health Plan that will pay their doctor for their care. Medicaid beneficiaries are responsible for showing proof of their Michigan Medicaid coverage when they make an appointment to see a doctor. Depending on your types of Medicaid insurance, your doctor will be able to tell that you are enrolled in Michigan Medicaid. You can simply show the doctor your health care card, which will be mailed to you if you do not have one already. Learn more about costs and coverage in our comprehensive Medicaid guide.

How much does Medicaid cost in Michigan?

If you are wondering, “How much does Medicaid cost?” you should know that the Michigan Medicaid program has copays. In terms of Medicaid health costs, most of the copays will be paid to a Michigan Health Account. For a beneficiary to qualify to receive coverage for Medicaid services, she or he is required to have an annual income between certain percentages of the federal poverty level (FPL) and to contribute a certain percentage of his or her annual income for cost-sharing purposes. Under Medicaid coverage in MI, the total cost sharing, which includes copays, can be reduced if a beneficiary participates in health behavior activities that include changing unhealthy activities.

What doctor’s visits are covered by Medicaid in Michigan?

If you qualify for Medicaid coverage in MI, you will be required to enroll in a Medicaid Health Plan that will pay your doctor for your care unless otherwise instructed. If you are receiving health coverage through Medicaid and have a current doctor that you would like to keep, you will have to check with that doctor to find out whether she or he participates in one of the Medicaid Health Plans.

For those beneficiaries who have Medicaid coverage through a health plan, dental services will be provided to them. Additionally, Michigan Medicaid covers family planning services with no out-of-pocket costs to the beneficiaries. Under this plan, both women and men can get access to family planning services.

What services are covered by Medicaid in Michigan?

The Michigan Medicaid Health Plan provides Medicaid coverage and the essential health benefits as determined by the federal government, as well as other services and benefits. Those additional benefits and services include ambulatory patient services and emergency services, hospitalization, mental health and maternity care. The services covered by Medicaid in MI also includes prescription drugs, rehabilitative services, certain devices, dental services, family planning, laboratory services, X-ray services and preventive and wellness services.

In MI Medicaid coverage includes such medically necessary services like an ambulance, dental work, doctor visits, emergency services, family planning, chiropractic, hearing and speech services, hospice care, home health care, outpatient care, inpatient hospital care, lab services, medical supplies and medicine prescribed by a doctor. Medicaid insurance in Michigan also includes mental health, non-emergency medical transportation, personal care services, nursing home care, pregnancy care (prenatal, delivery and post-partum), surgery, vision, X-ray, private duty nursing and immunization. It is important to note that some these services covered by Michigan Medicaid may require prior approval, and your provider will be able to tell you what services are covered.

If you qualify for coverage for Michigan Medicaid services, meet the financial Medicaid eligibility requirements and need long-term services in a home setting or a nursing facility, you must meet Medicaid’s medical requirements. It is important to note that these requirements are different than Medicaid’s financial requirements. The difference is that the Medicaid medical requirements for Medicaid coverage are determined by health care professionals who complete the Michigan Medicaid Nursing Facility Level of Care Determination (LOCD).

As for the family planning services offered by Michigan Medicaid coverage, they can help beneficiaries plan when to have a baby and how to prevent unwanted pregnancies. Under Medicaid, family planning services may include doctor’s visits, pregnancy testing and medical exams. Coverage for Medicaid in MI can also include birth control counseling and birth control methods, such as birth control pills and condoms, as well as testing for sexually transmitted infections (STIs), education and counseling.

What does Medicaid not cover in Michigan?

Those wondering, “What does Medicaid not cover?” should know that under Michigan Medicaid coverage, services that are in an urgent care center are covered. However, Medicaid does not cover emergency rooms visits if they are not deemed necessary. A medical emergency is defined as a condition where delay in treatment may result in a patient’s death or permanent impairment of the patient’s health. When it comes to transportation coverage under Medicaid, all non-emergency transportation must be approved before a visit. If you need help with transportation services, you can contact your local Michigan Department of Health and Humans Services (MDHHS) office or specialist. Learn more about Medicaid coverage and related costs in our in-depth guide.