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Learn About Medicaid Costs and Coverage in Montana

“How much is Medicaid in Montana?” and “What services are covered by Medicaid?” are both necessary question to ask when deciding if Medicaid is right for you. The following article will discuss how to establish Medicaid cost estimates for your family. You will learn the answer to the question “What does Medicaid not cover?” as well as how you can qualify for extremely low monthly payments for your medical coverage.

The cost of Medicaid coverage in Montana is dependent on multiple factors, including copayments, coinsurance payments, deductibles and other similar charges. 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 insurance company that provides your Medicaid coverage determines this amount. The copayment that your Montana Medicaid plan has you 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.

For more information on the services Medicaid provides, download our comprehensive guide.

How much does Medicaid cost in Montana?

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 MT 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.

What Services are Covered by Medicaid in Montana?

There are two types of Medicaid insurance in Montana 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. Once states have those benefits on offer, each state is free to decide what other Medicaid assistance they would like to provide their residents with. The following section of this article will discuss the differences between mandatory and optional Medicaid services and what they are.

Learn About Mandatory Medicaid Services

Mandatory Medicaid services are the Medicaid benefits that every state must offer its residents, as they have been instructed by the United States government, who regulate the Medicaid program benefits, to do so. In Montana, the mandatory services that the Medicaid program offers includes a wide variety of Medicaid program benefits:

  • Physician and Nurse Practitioner
  • Laboratory and X-ray
  • Family planning services
  • Home health services
  • Transportation

Learn About Optional Medicaid Services

Optional services are the services that Montana does not have to cover under their Medicaid coverage plans but chooses to anyway. Montana Medicaid coverage has optional benefits that outnumber their mandatory benefits. Some of the optional services you can choose from are:

  • Chiropractic services
  • Dental services
  • Hospice services
  • Prescription drugs
  • Mental health services

As with mandatory Medicaid benefits most of the optional services do not have an age limit for eligible applicants. Different types of hearing aid services and various therapy services, such as occupational, physical and speech require the patient to be younger than 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 Montana?

While Montana Medicaid covers many services and programs, they do not cover everything. 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 Montana Medicaid plan for any reason.

Learn About Types of Medicaid Insurance in Montana

Montana Medicaid offers a wide variety of different services and programs, some of which have already been discussed in this article.

The Program of All-Inclusive Care for the Elderly (PACE) is a Medicaid program under Montana 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 Montana 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.

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

Download our comprehensive guide to the Medicaid application process and learn how you can understand the documents and methods to apply.