What You Pay

If you have Medicaid, you don’t have to pay a monthly premium. You only have to make payments when you need medical care.

Generally, if you are 21 years old or older, you may have to pay small copayments when you use certain medical services that Medicaid covers. Prescription medications have small copayments of $3 or less.

You do not need to make copayments if you:

• Are under 21 years old
• Are pregnant
• Are an American Indian in a federally recognized tribe
• Are an Alaska Native
• Are in hospice care
• Live in a nursing facility, or
• Have breast cancer or cervical cancer

Note: Medicaid is much less expensive than other types of health insurance. Private insurance plans often have large copayments and annual deductibles, which means you have to pay thousands of dollars yourself before your insurance starts to cover services. If you qualify for Medicaid, you should sign up!

Medicaid with a spenddown

Some people with disabilities qualify for Medicaid with a spenddown, which is a way of getting Medicaid coverage by spending some of your own income every month. Note: This is very expensive. Before you sign up, make sure you look into all other health coverage options, including private coverage. You can probably find a more affordable plan.

Medicaid with a spenddown is like having a deductible every month: After you pay for a certain amount of medical costs for yourself and your family in a certain month, Medicaid covers your medical expenses for the rest of the month. The amount you have to pay, or "spend down," is the difference between your monthly countable income and the Medically Needy Income Limit ($317 for an individual; $375 for couples).

For example, Raheem's monthly countable income is $1,167, which is $850 more than the Medically Needy Income Limit. Once Raheem spends $850 on medical bills in a month, Medicaid will start paying for the rest of his covered medical expenses that month.

If your medical bills don't reach the spenddown amount in a particular month, you don't have to pay the whole spenddown that month.