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Learn About Medicaid Costs and Coverage in Minnesota

“How much is Medicaid?” and “how much does Medicaid cost?” are common questions that Medicaid applicants might be wondering after they qualify for coverage. In Minnesota, Medical Assistance (MA) is Minnesota’s Medicaid program. Services that the program pays for include doctor visits, hospital stays, and prescriptions, while some Medical services and prescriptions may require prior approval. There are no Medicaid costs for health care coverage in Minnesota for most Medical Assistance members. Types of Medicaid insurance for other members might state that they may have to pay a portion of the cost of service, which can include copays, deductibles or spend-downs. The state may give you Medicaid cost estimates when you apply for Medicaid coverage in Minnesota, and it may tell you the actual amount when you are approved for health care coverage. Copay, deductibles and coverage limits are known to vary by programs, and you will need to check with your plan before making any doctors appointments.

Download our helpful guide to understand more about how you can access the Medicaid application and determine eligibility.

Understanding the Types of Medicaid Insurance in Minnesota

In Minnesota Medicaid insurance, or Medical Assistance, is a joint program between both the state and the federal government. Medicaid benefits can be offered for up to three months before the month of the application. But only if the Medicaid applicant would have been eligible for coverage during the period they applied. Medicaid coverage typically ends at the end of the month in which the applicant no longer meets the requirements for Medicaid eligibility.

Your Minnesota Medicaid coverage starts the first month after payment has been made for your Medicaid plan and your continued coverage depends on the timely payments of premiums. MA in Minnesota states that Medicaid coverage for monthly premiums is based on family size, income and also the number of people in the family who are covered. Children younger than 21 years of age and who meet low-income guidelines can expect Medicaid cost estimates that include a fixed minimum amount a month.

What Services are Covered by Medicaid in Minnesota?

To determine what services are covered by Medicaid, the Medicaid beneficiary must get services from health care providers in their health plan’s network. If you are not enrolled in a health plan, you can get Minnesota Medicaid coverage on a fee-for-service basis from any provider who accepts Minnesota Medicaid.

In Minnesota, Medicaid insurance may include a copay, which is a small amount of the overall total bill that you will be responsible for paying when you get certain services, such as a prescription or eyeglasses. When it comes to how much does Medicaid cost in Minnesota, most of the MHCP programs have copay prescriptions and other health care services, and a Medicaid beneficiary’s health care provider will tell you if a copay is due.

Under MA, Medicaid costs for some adults will include deductibles and copays like:

  • Monthly deductibles
  • The copay for non-preventative visits (no copay for mental health visits)
  • The copay for prescription drugs (but there are no copays on mental help drugs
  • The copay for nonemergency ER visits

When it comes to how much is Medicaid, there are no Minnesota Medicaid costs such as deductibles or copays for refugees who have coverage through a Refugee MA program; people enrolled in the MA Breast and Cervical Cancer program and American Indians who have ever received care from Indian Health Services.

Medicaid coverage in Minnesota includes some services to participants. These services include alcohol and drug treatment, dental care for non-pregnant adults, chiropractic care, doctor and clinic visits and eyeglasses and emergency room (ER) care. Additional services include hearing aids, family planning services, hospice care, home care, mental health care, outpatient surgery, urgent care, rehabilitative therapy, licensed birth center services. If you need a service that is covered by Medicaid, it is important that you contact the provider before the appointment to make sure that they will accept your Minnesota Medicaid.

Download our guide to Medicaid to learn more about the kinds of services you and your family can benefit from.

How Much Does Medicaid Cost in Minnesota?

You may be wondering how much does Medicaid cost now that your application for MA has been approved. In MN, Medicaid coverage for the MA program pays for medical bills that go back three months from the month the application information is received. The specific program or MN Medicaid costs that an MA applicant qualifies for will determine which health care services are covered if there are limits on coverage for the applicant, and when they have to pay, if at all.

Medicaid cost estimatesfor the MA program in Minnesota states that there is a limit to five percent of the family income for monthly copays and deductibles. If a Medicaid applicant is not able to pay Medicaid costs like a deductible or copay, your provider still has to serve you. Providers cannot ask the applicant for proof that they cannot way. Guidelines for Medicaid coverage states that the providers must take their word that they will be unable to pay.

In Minnesota, there are Medicaid costs, like deductibles or copays, for children younger than age 21, pregnant women, people receiving hospice and people in nursing homes or another long-term care facility for more than 30 days, and people receiving hospice care. A Medicaid beneficiary will need to fill out a Minnesota Medicaid coverage form before MA can pay for most long-term services which include nursing homes.

There are also services covered by Medicaid that require a copay for services such as :

  • Services that are covered by Medicare, unless Medicare has a copay
  • Family planning services
  • Some prescriptions used for the treatment of mental illness
  • Refugees who have coverage through the Refugee Medical Assistance Program
  • Preventative services defined by the US Preventative Services Task Force (USPSTF)

What Does Medicaid Not Cover?

Under MA, services that are not covered by Medicaid in MN include autopsy, cosmetic surgery, medical cannabis, and experimental or investigational medications or devices. It also does not cover artificial ways to become pregnant, such as in vitro fertilization and fertility drugs, gender-reassignment surgery or medications used for erectile dysfunction or weight loss. Under Medicaid coverage in Minnesota, missed appointments, dental services that are deemed to be cosmetic or not medically necessary, and vocational or educational services are also not included in the MA program.