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Learn About Medicaid Costs and Coverage in Missouri

“How much is Medicaid in Missouri?” and “What services are covered by Medicaid?” are two questions commonly asked by individuals and families deciding if Medicaid is right for them. The following article will discuss the costs of Medicaid in Missouri, and what Medicaid covers.

In Missouri, before you get Medicaid cost estimates, you should be aware of the two types of Medicaid coverage that the program covers: mandatory and optional. Federal law requires states to provide certain benefits to anyone enrolled in Medicaid who is receiving Medicaid benefits. If you are wondering, “What services are covered by Medicaid?” you must look to your state to understand more about their elected health coverage services. Once states have those benefits on offer, each state is free to decide what other types of Medicaid insurance they would like to provide their residents with. The following section of this article will discuss the differences between mandatory and optional Medicaid services as well as what these options provide. Download our comprehensive guide to Medicaid to learn more about the program.

How Much does Medicaid Cost in Missouri?

The cost of Medicaid coverage in Missouri is dependent on multiple factors, including copayments, coinsurance payments, deductibles and other similar charges. The first factor of your Medicaid cost estimates is your copayment, which is a set amount of money you have to pay each time you visit your doctor. The company that provides your Medicaid benefits determines the amount of your monthly insurance payment. The copayment that your Missouri Medicaid coverage plan requires you to pay is also based off of your allowable cost, which is the maximum amount your insurance plan will pay for certain medical services. A payment type similar to a copayment is a coinsurance payment.

The coinsurance payment that your Medicaid benefits asks you to pay is a percentage of your allowable cost. The amount of your copayment or coinsurance payment is determined by the service you need and who you receive it from. For example, the Medicare coverage benefits copayment and coinsurance amounts that you pay for your doctor’s visits may differ from those you pay for a visit to your dentist. Note: You may have to pay either a copayment, coinsurance payment, or both in a single visit depending on the services you require at the time of your visit. It is also possible that different visits will require you to make different types of payments.

The second factor used to determine your Medicaid coverage costs is your deductible, which is a fixed amount that you have to pay for your health care before your Medicaid coverage insurance plan takes over the costs of your medical care. Once you have paid the full amount of your deductible, you will only have to pay either your copay or your coinsurance amount. Download our helpful guide to better understand the Medicaid application process.

What Services are Covered by Medicaid in Missouri?

Mandatory Missouri Medicaid coverage includes the Medicaid benefits that every state must offer its residents, as the United States government has instructed them, who regulate the Medicaid program’s benefits, to do so. In Missouri, the mandatory services that the Medicaid program offers includes a wide variety of Medicaid program benefits:

  • Professional Certified midwife services
  • Child health services
  • Family planning services
  • Home health services
  • Dentistry services, including medical and surgical

For the most part, your Medicaid coverage services include all age groups, from children to adults. However, some may have age limits applied to them. For example, Child Health Services is only for individuals who are under the age of 21 years old. Your Medicaid benefits also include nursing facilities services, which are also only for anyone younger than the age of 21 years old. On the other hand, the transportation service Missouri Medicaid provides to and from medical providers is for anyone of any age, as long as the service is eligible based on medical necessity.

Understanding what does Medicaid not cover, is just as important as understanding mandatory offerings. Optional services are the services that Missouri does not have to cover under their Medicaid coverage plans but chooses to anyway. Missouri Medicaid coverage optional benefits outnumber their mandatory benefits. Some of the optional services you can choose from are:

  • Chiropractic services
  • Dental services
  • Hospice services
  • Prescription drugs
  • Medicare crossovers

As with mandatory Medicaid benefits, most of the optional services do not have an age limit. However, some do. Different types of hearing aid services and various therapy services, such as occupational, physical and speech require the patient to be under the age of 21 years old. Meanwhile, medical supplies and prescription drugs are available to Medicaid beneficiaries of all ages.

What does Medicaid not Cover in Missouri?

While Missouri Medicaid covers many services and programs, they do not cover everything. When you understand the application process, you will be able to provide verification to access the services that are offered in Missouri. Medicaid does not cover treatments that are untested or that are still in the testing phase. Medicaid also will not cover anything that your Medicaid coverage plan does not consider medically effective, as well as any treatment that is not considered normal for your illness or injury and any services that do not have guidelines to regulate them. Your Medicaid coverage also does not cover any kind of cosmetic surgeries that you would use to improve your appearance, private nursing services, massage therapy, chiropractic care or medical services given by a family or friend.

While Medicaid coverage includes prescription drugs, it might not include all of them. For instance, fertility drugs, cosmetic drugs and weight loss drugs are not covered under your Missouri Medicaid plan for any reason.

Learn About Types of Medicaid Insurance in Missouri

Missouri Medicaid offers a wide variety of different services and programs, some of which have already been discussed in this article. Some other types of Medicaid insurance are as follows:

  • The Program of All-Inclusive Care for the Elderly (PACE)
  • Long term care
  • Workers with Disabilities program
  • ARChoices

The Program of All-Inclusive Care for the Elderly (PACE) is a Medicaid program under Missouri Medicaid that provides individuals with comprehensive health and social services benefits that include coordinating primary, preventative, acute and LTSS care for individuals who require the assistance of nursing homes.

Long term care is reserved for individuals with Medicaid coverage who currently live in nursing homes. They may qualify for Medicaid’s long-term care program if they are deemed medically needy and meet the income and resource requirements, among other criteria.

The Missouri Medicaid Workers with Disabilities program is for individuals who are disabled but are still working, either part time or full time. If they qualify, they will qualify for full Medicaid coverage. However, their income will determine how much their copayments will be. Individuals with a lower income will pay the normal Medicaid coverage copay, while individuals with a higher income will pay higher copays.