Medicaid, though funded by the federal government, is managed by state agencies. Each agency has the power to customize their program, and this can include imposing co-payments, deductibles, and so on. If you or a loved one receives Medicaid benefits, you need to know how Medicaid handles out-of-pocket costs.
Do I have to pay out-of-pocket expenses?
Many patients are expected to pay co-payments on expenses like:
- Office visits to doctors, optometrists, nurse practitioners, and other healthcare providers).
- Hospital care, including those provided at federally qualified health centers, rural health clinics, inpatient, outpatient, and ambulatory surgical centers.
- Durable medical equipment,
- Medical supplies and appliances, and
- Prescription drugs.
The co-payments are small. However, health care providers cannot deny services if a Medicaid recipient cannot pay the co-payment.
Are any services exempt from out-of-pocket charges?
Yes. Out-of-pocket fees by law cannot be charged for:
- Emergency services,
- Family planning services,
- Pregnancy-related services, or
- Preventive services for children.
Are any groups exempted from paying out-of-pocket fees and co-payments?
Yes, some Medicaid recipients are not expected to pay such fees:
- Children,
- Terminally ill people,
- Nursing home residents,
- Native American Indians with an active user letter from Indian Health Services,
- People receiving emergency treatments, and
- People receiving family planning services.
Check with your Medicaid caseworker to make sure you are not charged for co-payments and out-of-pocket expenses if you are included in one of these groups.
Will Medicaid repay my out-of-pocket expenses?
Not exactly.
Sometimes Medicaid will be awarded retroactively. This means that earlier costs that are eligible for Medicaid coverage may be paid. However, the patient is responsible for contacting the health care provider responsible for anything they paid for themselves. The provider will submit the services to Medicaid and typically reimburse the patient after receiving the payment from Medicaid.
First, You Have to Get Through the Medicaid Application Process.
It’s complicated and difficult, but we can help. We have helped many clients navigate federal and state guidelines to get the benefits they deserve.
The attorneys at Miller Estate and Elder Law assist their clients with all phases of estate planning and incapacity planning. For a free consultation, contact us at 256-251-2137 or use our convenient Contact Form. Although we’re located in Anniston, we also help clients in the Birmingham, Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
