Medicaid Costs and Coverage in Washington

The question, “How much is Medicaid in Washington?” is just one of the many questions asked by residents regarding the Medicaid/Apple Health program. With different types of Medicaid insurance available through the Washington Apple Health program, the pricing to receive coverage may vary. Most beneficiaries receive Apple Health coverage at no additional cost, while other beneficiaries may need to pay small amounts of money at the time of service. These are called copayments. The question, “How much does Medicaid cost?” has a variety of answers, so receiving Medicaid cost estimates can be a great way to have a general idea about what you may be expected to pay. In addition, “What services are covered by Medicaid in WA?” is another question that many residents have. To learn more about Medicaid costs and coverage, review the sections below.

How much is Washington Medicaid?

“How much is Medicaid in Washington?” is a very important question. Receiving Medicaid cost estimates can help households to understand how much Medicaid costs in Washington. However, the costs for Medicaid can vary greatly from household to household, even among those who meet all of the Medicaid eligibility requirements. Therefore, specific numbers cannot always be provided. A lot of beneficiaries pay nothing for Apple Health coverage, or they pay very little. The Medicaid program was designed to offer low-cost programs for medical insurance coverage to eligible low-income households, so the payments required are often much less expensive than standard insurance plans. How much Medicaid is for a certain household depends on a variety of factors, including financial circumstances, household size and composition. The different types of Medicaid insurance will also incur different costs. Learn more about these costs in our comprehensive Medicaid guide.

To estimate the cost of Medicaid in Washington, you must consider the copayments that may be required. Answering the question, “how much does WA Medicaid cost?” requires understanding that some beneficiaries must pay a certain amount of money when certain medical services are provided. In terms of Medicare coverage costs, this flat dollar amount of money is referred to as a copayment, and the exact amount depends on the service being provided. To determine whether or not a Medicaid copayment amount will be required and to see how much you may be expected to pay, call your medical care provider before the appointment.

What services are covered by Medicaid in Washington?

Understanding what services are covered by Medicaid is important before you attempt to use your coverage for services, supplies or medications. The services covered by Medicaid vary in each state because the program in each state is different. Therefore, you need to know what Medicaid services are covered in Washington if you are a Medicaid recipient in the state or are interested in becoming a Washington Medicaid recipient. Learn more about services covered through Medicaid by downloading our in-depth guide today.

It is also beneficial to note that different types of Medicaid insurance exist within the Apple Health program, and there are variations in what services are covered in each insurance type. This means that it is always important to check with your health care provider to determine whether or not a service is covered. The following services are generally covered by Medicaid:

  • Outpatient appointments: These appointments may be with a physician or other medical professional, and all appointments must be for necessary care. In terms of Medicaid-covered services, outpatient procedures describe surgery, tests or other services that can be completed in one day without necessitating an overnight stay at a hospital or another facility.
  • Hospitalization and emergency medical care: Medicaid coverage is also extended to emergency care and inpatient services at a hospital. However, it is important to note that this type of service may require a copayment.
  • Certain prescription medications: Most prescription medications are covered by Washington Medicaid, but you must check with your Apple Health plan in order to know for sure what drugs you can and cannot receive full coverage on. If a certain medication is not covered by your plan, there may be the option to receive a similar medication that is covered or request that a preauthorization be submitted by your health care provider.
  • Maternity and newborn baby care: Coverage from Medicaid covers most maternity and newborn services including prenatal care, delivery services, post-pregnancy follow-up visits and a full year of medical care for newborns.
  • Transportation: Non-emergency transportation is covered by the Apple Health program. This service is provided to beneficiaries who need transportation to and from medical appointments. Also, emergency transportation in the form of an ambulance, either ground or air, is covered by Medicaid programs as well.
  • Dental and vision care: Most basic dental care is covered by Medicaid in Washington for both adults and children. Services covered generally include, but are not limited to: examinations, cleanings, X-rays, fillings and extractions. However, the exact dental care coverage may vary depending on the Medicaid plan.

In addition, services covered by Medicaid include alcohol dependence, mental health treatment services and laboratory services. Also, an interpreter for your appointment can be covered if you do not speak English and therefore need interpretation services.

What does Medicaid not cover in Washington?

Most services are covered by Medicaid in Washington, but it is important to remember that the program does not cover every service. However, Washington Medicaid coverage may be provided as long as they are preauthorized by your physician. If you require a service that is not covered by your Medicaid plan, you can have your medical care provider submit a request for preauthorization that states why you need that particular service. After the request has been submitted, you will receive notice regarding whether preauthorization was approved or denied. It is important to note that certain excluded, experimental and investigational services will not be covered even with a preauthorization.

The services not covered by Medicaid change frequently, so it is important to always be aware of what services are currently not being covered by the medical assistance plan you have. Certain services are not covered even if they are deemed medically necessary. A few examples of services not covered by WA Medicaid include cosmetic surgery and services, dietary or food supplements, experimental or investigational services or drugs, weight loss treatments, incarceration services, hospital inpatient charges for nonessential services, massage therapy and more. Be sure to understand costs and coverage for the program before you complete the Medicaid application procedures.