Medicaid Costs and Coverage in New Jersey

You may ask, “How much does Medicaid cost in New Jersey?” before signing up for insurance through Medicaid. Medicaid cost estimates differ depending on your circumstances. There are several different types of Medicaid insurance available in New Jersey that you can choose from, depending on your /new-jersey for a certain group, such as pregnant women or disabled individuals. The answer to the question, “How much is Medicaid?” includes various costs like copayments or premiums, depending on the income and composition of the household. It is important to know what services Medicaid covers before you choose a plan, as not all Medicaid plans cover the same services. For instance, emergency medical transportation may be covered in one plan but not covered in another. It is important to compare the plans before deciding on which one is best for you. For more information on what services are covered by Medicaid, the costs of different Medicaid services, information on what does Medicaid not cover and more, you can refer to the sections below.

What services are covered by Medicaid in New Jersey?

There are certain services covered by Medicaid that are always included in plans for those who meet eligibility requirements for Medicaid. Medicaid coverage on these services must extend to everyone using Medicaid. These mandatory services include inpatient and outpatient hospital treatment, as well as lab tests and X-rays. Covered Medicaid services also include early and periodic screening for a condition, along with diagnostic services and treatments. Services provided by Medicare include home health care, physician services and nurse-midwife services. If you need help with family planning, that is also covered by Medicaid in New Jersey. If you are over 21, nursing facilities are part of mandatory coverage.

Some services covered by Medicaid in NJ are considered optional services because the federal government does not require states to provide them. Some of the optional services covered by Medicaid are only for patients in specific FamilyCare programs. These services include treatment in residential treatment centers and optical appliances. Certain specialized care services may fall in the optional Medicaid coverage category, such as dental care, optometry services and chiropractic services. If you need to see a psychologist or podiatrist, those visits may be covered by Medicaid, depending on the healthcare plan that you have chosen. Prosthetics and orthotics also fall into this category. Depending on your plan, Medicaid coverage may extend to drugs necessary for long-term care, as well as drugs that are at retail cost. Durable medical equipment, transportation hearing aid services and hospice care are also optional service. Some programs may extend Medicaid coverage to transportation to appointments, while some only cover emergency transportation. Personal care services are not mandatory, but may be covered. Licensed practitioner services, as well as services provided in a clinic, are also optional. If you require private duty nursing, that may be covered by Medicaid, depending on your program. Physical, occupational and speech therapy are all optional. If you are under 21 years old or over 65 years old, Medicaid coverage may include inpatient psychiatric care and treatment in intermediate care facilities for people with developmental disabilities.

To learn more about services covered by Medicaid, download our Medicaid guide for national program details.

Types of Medicaid Insurance in New Jersey

There are different types of Medicaid insurance in New Jersey that you can choose from during the application process. The Medicaid coverage for each program differs. In New Jersey, Aetna Better Health of New Jersey, Amerigroup, New Jersey, Inc., Horizon NJ Health, UnitedHealthcare Community Plan and WellCare plans offer managed care services for Medicaid patients. Note that not all of these plans are available in every county. Amerigroup, New Jersey, Inc. Medicaid coverage plans hearing services, including diagnostic, screening, preventative and corrective services, as well as necessary supplies and equipment. This Medicaid coverage also extends to behavioral health, which includes mental health and substance use disorder (SUD). SUD services include intake evaluations, off-site crisis interventions, family therapy, family meetings, psychological testing and drug management. This Medicaid coverage includes chiropractic services and dental services, as well as durable medical equipment and early screening, diagnosis and treatment of conditions. Certain drugs are also covered. Neonatal exams are covered within certain timeframes by this plan. The Medicaid coverage differs depending on the plan offered by providers. For example, AETNA Better Health of New Jersey has several different plans that can cover clinic services, colorectal screening exams, dental services, orthodontic services, diabetic education and supplies, early and periodic screening and treatment, emergency room care, emergency transportation and eye exams. For more information on Medicaid coverage for these plans, refer to the individual plans.

Before completing the application process, many people wonder how much Medicaid is in New Jersey and if all plans cost the same amount. Medicaid cost estimates differ from plan to plan, and it varies by household composition and income. Some plans have copays for services, and certain specific coverage options can vary by provider. Horizon New Jersey has its own set of services that are covered. Emergency medical care services are covered by Medicaid, and the program also provides early and periodic screening for diseases and diagnosis and treatment. Family planning, group homes, DCPP Residential Treatment Facilities and hearing aid services are also covered. If you require home health agency services, such as nursing services by a licensed nurse, home aide service, medical supplies, pharmaceutical services and more, they are also covered. This Medicaid coverage extends to hospice services, hospital services, both in and outpatient, laboratory services, medical day care, maternity services and more in certain Horizon New Jersey plans. It is important to search and compare all of the Horizon New Jersey plans for Medicaid coverage specifics before choosing the one that you wish to enroll in.

The UnitedHealthCare Community plan is also available in New Jersey. Through it, Medicaid coverage extends to primary care services, including checkups, treatment for colds, health screenings and checking on health concerns. You can choose any of the Primary Care Providers in the plan’s network. The Medicaid coverage offered through this plan also covers services from specialists. In some cases, you will need a referral from your Primary Care Provider before you can see a specialist. This Medicaid coverage includes prescription drugs no matter your age. Depending on your plan, you may have a copay. Insulin, needles, syringes, birth control, aspirin for arthritis, iron pills and more are also covered. With this plan, you are also covered for any hospital stays and outpatient services you may need. For more information about Medicaid costs and coverage, download our national Medicaid guide for program details.