Medicaid Costs and Coverage in Virginia

“How much is Medicaid in Virginia?” is a question commonly asked by residents of the state. Medicaid cost estimates can be helpful in giving you a good idea of what you may need to pay in order to receive Medicaid coverage. Depending on which Medicaid eligibility requirements you meet when you apply, you may not need to pay anything at all. “How much does Medicaid cost?” is a question with a variety of answers, depending on the individual situation of each household. Additionally, understanding what services are covered by Medicaid can help you to know whether or not receiving Medicaid health coverage assistance in Virginia would be a benefit to your household. It is important to know what services are covered by Medicaid in Virginia before you begin the application process, as everyone has specific health concerns. To learn more about types of Medicaid insurance and find out how much Medicaid costs, review the sections included below.

What services are covered by Medicaid in Virginia?

Knowing what services are covered by Medicaid in Virginia is crucial if you want to utilize your coverage as intelligently as possible. Also, asking the question, “What does Medicaid not cover?” is important as well, since coverage varies depending on state. Any services not covered by Medicaid in Virginia that have been performed on you will not be paid for by Medicaid, so you will be responsible for the full bill payment. Each state has different services and items that it provides as part of the Medicaid coverage plan, which can be confusing, so you must have a good understanding of what services are covered in the state of Virginia specifically before seeking non-emergency treatment. The services covered by Medicaid include but are not limited to:

  • Dental CareMost dental care is generally only provided to children. This includes diagnostic, preventative, surgical procedures and orthodontic services. Routine dental care services are not covered for adults. Only medically necessary oral surgery services are covered for adults aged 21 years or older.
  • Medical Professional Visits and Out-Patient Clinic ServicesServices that are covered by Medicaid include diagnostic, psychiatric, physical therapy, occupational therapy, nursing and speech therapy visits. However, you may be limited to only a certain number of professional visits, and additional appointments may need to be pre-approved.
  • DrugsCertain drugs are included in what services are covered by Medicaid, and they are generally part of the Preferred Drug List (PDL). However, with certain Virginia Medicaid coverage, you may need to receive pre-authorization from your doctor depending on the prescription drugs you need. Also, in some cases, equivalent over-the-counter medications will be provided in lieu of certain prescription medications. For Medicaid-covered drugs, generic options are most likely to be provided unless the doctor notes that a particular name brand medication is necessary for treatment.
  • School Health ServicesChildren who are eligible for Medicaid who receive health-related services through public schools may have the costs associated with these services covered by Medicaid because the medical assistance program can help the public school division pay for those services. These services may include speech therapy, audiology, psychological or personal care services and health screening.
  • Inpatient Hospital AdmissionHospital admission will be covered by Medicaid. However, the coverage is only available if your doctor calls ahead of time for a pre-authorization or within 24 hours after you are admitted in the case of an emergency. To learn more about the cost of inpatient procedures, download our in-depth Medicaid guide.
  • TransportationMost VA Medicaid coverage programs cover both emergency and non-emergency transportation costs. Emergency transportation is typically a result of a 911 call either and occurs either via ambulance or helicopter. Non-emergency transportation is generally provided through a transportation broker or a Managed Care Organization (MCO) and is only covered if you have no other means of travelling to a physician or health care facility and only if it has been pre-authorized.
  • Out-of-State Medical CoverageMost types of Medicaid insurance programs will cover emergency medical services that you had to receive while temporarily outside of the state of Virginia and only if the care provider agrees to bill Virginia Medicaid.

What does Medicaid not cover in Virginia?

Although many services are covered by Medicaid in Virginia, there are quite a few medical services that are not covered. Services Medicaid does not cover must be paid by you. The following are just a few of the services that are not covered by Medicaid: acupuncture, certain drugs that are not proven effective, most chiropractic services, fertility treatments, certain experimental procedures, remedial education and more. Learn more about medical costs by downloading our comprehensive Medicaid guide.

How much is Medicaid in Virginia?

“How much is Medicaid in VA?” is an important question. How much Virginia Medicaid costs varies from household to household. For most households, Medicaid costs absolutely nothing. This depends on the types of Medicaid insurance the household receives. VA Medicaid cost estimates are difficult to provide because the amount of money that a household may be required to pay is dependent on a number of different factors including the medical services needed, the financial situation and the composition of the household.

How much Medicaid costs also depends on the co-payment amounts required as well. Some types of Medicaid insurance in VA require certain members to pay a small amount of money called a copayment for specific services. However, copayments are not required for children younger than 21 years of age or for members receiving hospice or long-term care services, emergency services, pregnancy-related services or family-planning services. In general, how much Medicaid services cost in terms of a copayment is usually only a few dollars. However, that is just a cost estimate for VA Medicaid, and the amount can be much higher for certain treatments such as in-hospital admission, where the copay in Virginia is $100. Higher copayments are generally associated with surgeries and other more intensive procedures. If possible, it can be very beneficial to call the clinic ahead of time to determine how much the Medicaid copayment is so that you can be very prepared. It is important to note that if the Medicaid member is unable to pay the co-payment, the medical services will still be provided. However, the copayment will still be due at a later time. In general, it is a good idea to understand how Medicaid costs and coverage work before following the Medicaid application process.