Medicaid Costs and Coverage in Texas

If you have asked, “How much is Medicaid in Texas?” you might be one of the thousands of low-income Texans who need help with paying for medical costs. Although many residents could benefit from Medicaid, it may seem difficult to access without the right information ”How much does Medicaid cost?” is the primary concern when families consider the program. Medicaid, like many other government topics, can be a confusing program to jump into without prior knowledge. However, Medicaid cost estimates do not have to be imposing or scary figures. In fact, depending on the types of Medicaid insurance that you need, you may not even have to pay for them at all. This article will help you to identify what services are covered by Medicaid in Texas, and how much you may need to pay for them.

Who is responsible for establishing Medicaid costs and coverage in Texas?

Before you can learn the costs of Medicaid in Texas, it is important to understand who provides Medicaid insurance coverage in the first place. Medicaid coverage is regulated by the Texas Department of Health and Human Services (HHS), which is also the state’s agency for Medicaid eligibility and application. They provide Medicaid coverage options to those low-income Texans who provide them with the right eligibility documentation, as well as a completed application. They also provide different types of Medicaid insurance depending on special eligibility requirements, through the Children’s Health Insurance Program (CHIP) and Medicaid for the Aged, Blind and Disabled Program (ABDP). After you have applied for traditional HHS Medicaid coverage or special CHIP/ABDP insurance, you will receive a letter in the mail that details how much coverage you will receive, and how much you will need to pay for said coverage.

Download our comprehensive guide to Medicaid to learn how your family can save on necessary medical care.

How much does Medicaid cost for low-income Texans?

Before you actually apply through HHS, Medicaid cost estimates can be difficult to generate for a number of reasons. Perhaps the biggest reason is that Medicaid costs in Texas vary from person to person – plus, they also change on a somewhat regular basis because of the change in national healthcare costs. Certain Medicaid costs, such as monthly premiums and hospital/doctor deductibles, do exist for most Texas Medicaid recipients. However, these Medicaid cost estimates can oftentimes be very low, and they can even be nonexistent for those cases where an applicant shows a true need for significant financial aid. You can only be eligible for TX Medicaid coverage if you make under a certain amount of household income every year – and as such, HHS wants to ensure that they are providing decent insurance coverage at reasonable price points. Your own specific Medicaid prices will be conveyed to you upon your submission of the required forms to the Texas HHS.

Establishing What Services Are Covered by Medicaid in Texas

You can easily determine what services are covered by Medicaid by considering that the Texas HHS works with other federal and private health insurance programs in order to cover certain medical costs. These Medicaid covered services must be considered “medically necessary” for the recipient in order to receive funding. To start, Medicaid coverage extends to all of the most basic health and welfare services, such as doctor appointments, inpatient and outpatient hospital visits, prescription drugs, dental maintenance appointments and non-emergency medical vehicle use.

Certain types of Medicaid insurance in Texas provide extended coverage in order to pay for more expensive services that your traditional health insurance may not completely cover. Such Medicaid coverage options include physical, occupational and speech therapy services, mental health care, hearing and vision care, X-rays and more. The Medicaid premiums and deductibles that you may be asked to pay for these services could be dramatically reduced, depending on the quality of your primary health insurance. For example, Medicare patients will have a majority of these Medicaid covered services at least partially covered, and so Medicaid may be able to cover the remainder of the costs.

Some other types of Medicaid insurance apply only to those Texans who qualify to apply for special Medicaid benefits under the CHIP or ABDP programs. CHIP is Medicaid coverage for children who have not yet turned 19 years of age and focuses on traditional Medicaid covered services as well as pediatric care and child-specific vaccinations. ABDP, on the other hand, is special Medicaid coverage for seniors (65 years of age and older), blind or disabled Texans. This type of Medicaid insurance focuses mostly on hospice care, in-home nursing care and accessibility services.

What does Medicaid not cover in Texas?

Answering the question, “What does Medicaid not cover?” is also extremely important for low-income Texans who may be struggling to pay for their health costs. While the above Medicaid covered services are considered “medically necessary” by the Texas HHS, there are also a number of services that are not believed to be vital to maintaining public health. Services without Medicaid coverage are those such as experimental remedies or treatments, massage therapy/acupuncture/chiropractic services, cosmetic surgery or medical treatment that is provided by a family member. While most types of Medicaid insurance do not cover these services, Texas residents can always file an appeal to HHS in order to have such services reviewed for potential Medicaid funding. Medicaid coverage is not always the same around the country or even another city in Texas. Therefore, it is critical to contact your local HHS branch to find out if said service is available in your area.

TX Medicaid Coverage & Cost Factors to Consider

Some Texans may wonder why Medicaid coverage is even necessary – with the right amount of health insurance, some individuals do not need any additional coverage. However, Medicaid insurance benefits are one of the best ways for low-income Texans to supplement their health insurance, and pay even less on medical bills than they normally might. Medicaid cost estimates can vary fairly widely, depending on what kind of Medicaid covered service you are needing financial aid for. Taking advantage of Medicaid coverage when it is available, you may be able to pay hundreds (or less) on a service that might have normally costed thousands of dollars without any help from Medicaid whatsoever. In this light, Medicaid insurance costs are generally considered to be an excellent investment for the long-term health of low income Texans and their families.

To discover the services covered under Medicaid and how you can determine if you qualify, download our helpful guide to Medicaid.