Medicaid is a federal-state public health insurance scheme for low-income earners, children, pregnant women, the aged, and the disabled. Medicaid is a free program that offers access to quality health care for those who cannot afford quality healthcare and other health insurance plans. Do Medicaid patients, therefore, pay cash?
Medicaid patients can pay cash by using their cards or personal cheque in some instances which is dependent on the medical care provider’s choice. Medicaid patients can as well save money by paying their bills out-of-pocket for health care services provided it is accepted at the healthcare center but there are claims that it’s illegal.
Medicaid patients are sometimes responsible for out-of-pocket Medicaid costs such as spend-down amounts, deductibles, and co-payments. For this article, we will discuss in detail why Medicaid patients can pay cash and all you need to know about Medicaid patients’ out-of-pocket costs. Scroll down the paragraphs below for further details.
What to know about Medicaid patients paying cash?
Medicaid covers a wide range of health services and limits patients’ out-of-pocket expenses for prescriptions and services. Medicaid patients have limited ability to pay out-of-pocket expenses as a result of their meager and modest incomes. Medicaid cash payments are determined by the medical center providing health care.
However, there are some rules and regulations for out-of-pocket expenses and costs that are dependent on the income earned by those earning incomes.
• To be a Medicaid enrollee or patient and whether to pay out-of-pocket costs or not is dependent on the state of residence, medical status and Modified Adjusted Gross Income (MAGI) of each individual.
Medical is a joint state-federal health partnership that confers power on the state to make some decisions. For Medicaid, the federal has its own rules so does the state. The state sets the standard for each service and charges required such as co-insurance, income-based co-payments, deductibles, and other charges for both outpatients and inpatients.
For the income-based co-payments, there is a maximum co-payments that can be charged by the service provider at the Medicaid center.
• For very low salary earners within the greater poverty level, they are not required to make out-of-pocket payments, they cannot pay cash but pay lower co-payments. Medicaid patients who still cannot afford the least co-payments would not be turned away by medical health providers but will be held accountable for co-payments yet unpaid.
Income earners that are not within the poverty level can be a part of Medicaid as well, but they would pay spend-down amounts or deductibles.
These spend-down amounts must be made known to the Medicaid center before you can a become bonafide Medicaid patient and your enrollment becomes active. After such income earners have completed their deductible payments to cater for their medical expenses, their Medicaid enrollment becomes active and caters to other medical expenses yet unpaid.
Other conditions and criteria
Other conditions and criteria that are accessed to determine if a Medicaid patient can pay cash out-of-pocket include;
• Patients who have received services from the Indian Health Service before coming to Medicaid care.
• Patients already enrolled in the Breast and Cervical Cancer Treatment Program.
• Children services
• Terminally ill individuals services.
• Pregnancy-related services.
• Family planning services.
• Services for individuals living in institutions and home care houses.
• Patients who have received services from tribal health programs before coming to Medicaid center care.
What are the possible implications of Medicaid patients paying cash?
Medicaid patients who wish to pay cash can do so provided they are not in the given category of those who are cannot pay out-of-pocket.
Medicaid patients who are on high-deductible insurance plans can choose to negotiate with the health provider and pay cash instead of through insurance. It is often easier to discuss with the health provider about the medical expenses than to discuss with the insurance company.
Some health providers even offer discount prices to those patients who decide to pay cash. Scenarios like this are often applicable to medical procedures such as CAT scans, ultrasounds, lab work, X-rays, and prescriptions as well.
Medicaid patients can pay cash or out-of-pocket for their health services provided they can afford it and if the health provider is willing to accept cash. Some states allow patients to pay cash for a particular health service which is sometimes more expensive or less expensive than your Medicaid co-payments and spend-down deductibles.
Frequently Asked Questions.
- If my income exceeds the poverty level, can I still have access to Medicaid?
Yes, you can. You can still be qualified to be a Medicaid patient if only you would spend your income on medical expenses.
- Can I be billed even tho I’m not yet a Medicaid patient?
Yes, the Medicaid health providers can bill patients and go as far as taking debt collection measures even when a patient is not yet an active Medicaid patient.