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In this Idaho health care guide, you’ll learn what Idaho Medicaid is, including information on who is eligible and how to apply. We’ll also describe the coverage under Idaho Medicaid and detail what each plan covers and doesn’t cover.
If you need medical services that Medicaid won’t cover, you can find affordable third-party health insurance plans that extend your health coverage. Insurdinary makes it easy to compare multiple insurance plans so you can find coverage at the best price. We can optimize your coverage to include a more comprehensive range of benefits and services by way of private health insurance.
The Idaho Medicaid plan provides healthcare coverage for low-income adults, seniors, pregnant women, and people with disabilities who meet the plan’s specific income requirements. The state of Idaho and the federal government of the U.S. jointly provide funds for the Idaho Medicaid program, enabling the plan to offer free or low-cost health coverage to individuals who need it.
Idaho Medicaid offers three different healthcare coverage programs, each with certain criteria for eligibility. Depending on your circumstances, you could be eligible for one of the following three Medicaid plans:
The Enhanced Plan includes all the benefits of the Basic plan plus extra benefits, and the Medicare-Medicaid Coordinated Plan has all the benefits of the Enhanced Plan plus access to the managed care plan.
A managed care plan, such as Idaho’s Healthy Connections program, gives you access to a care coordinator who can help you get appropriate health care for your complex medical conditions. Most people with Idaho Medicaid must enroll in Healthy Connections.
Whether or not you have co-payments depends on factors including your age and income, and you’ll find out if you have co-payments and how much they are when you start your Idaho Medicaid plan. Your monthly premium could be between $0 and $15, depending on your income.
If you apply for Idaho Medicaid and are eligible, you’ll receive an identification card in the mail. You’ll present your Idaho Medicaid card to your health care providers, including your primary doctor and pharmacy. You might have to show a picture ID along with your Idaho Medicaid card.
You should always show your Medicaid ID card before receiving medical services to determine whether the provider accepts Idaho Medicaid, even if your doctor referred you to a specific specialist.
If your name changes, you need to report it to the Health and Welfare office to get a new ID card. In some cases, a provider won’t accept your Medicaid card if you’re going by a different name.
Your Idaho Medicaid card is permanent, meaning that even if you lose benefits and regain them later, you’ll be using the same ID card. It’s best to keep your card in your wallet or purse so you have it whenever you might need it.
To apply for Idaho Medicaid, you need to fill out an application for the plan. You can complete an application in the following ways:
You can receive an application in English or Spanish, and language interpretation services are available. Parents and guardians can apply on behalf of their dependent, and you can get friends or family to help you fill out the form if needed.
You will need the following information for your application:
If you filled out a paper application, you can submit it in the following ways:
Your Idaho Medicaid application can take up to 45 days to process, and, upon approval, the health department will choose a Medicaid plan that fits your needs.
Each plan under the Idaho Medicaid program has different eligibility requirements, and your circumstances will determine which plan is suitable for you. To qualify for any of the Idaho Medicaid plans, you must live in Idaho and be a U.S. citizen or eligible non-citizen.
All adults with an income under 138% of the federal poverty level (FPL) are eligible for Medicaid, regardless of health conditions.
Here are a few examples of income limits for different Idaho Medicaid health programs:
When determining your income and the value of your assets, you should identify what counts towards your eligibility.
For example, your countable income includes employment wages, alimony, pension, Social Security Disability income, and Supplemental Security Income. If only one spouse in a married couple is applying for Medicaid, the spouse’s income doesn’t count.
Regarding your resources (or assets), you must count things like cash, stocks, bonds, bank accounts, leftover funds from COVID-19 stimulus checks, and real estate. Exemptions include personal belongings (clothes, furniture, etc.) and your primary home.
If you’re married, you must consider you and your spouse’s assets as jointly owned.
The following is an overview of the general eligibility criteria for each Medicaid plan:
You’ll receive an Idaho Medicaid card within two weeks after approval of your application. If you don’t receive your card after 14 days, you should contact the Health and Welfare department at 877-456-1233.
As we mentioned in a previous section, you should keep your card in your wallet or purse, ensuring you always have it to show your doctor or other care provider.
If you change your name or lose your Idaho Medicaid card, you can get a replacement by contacting the Idaho Department of Health and Welfare at 877-456-1233.
Your Idaho Medicaid coverage depends on which plan you’re eligible for. All plans have the benefits of the Basic Plan, but the Enhanced Plan and Medicare-Medicaid Coordinated Plan include a few additional benefits.
Below, you can find brief examples of services you might have coverage for from your Idaho Medicaid plan.
Idaho Medicaid covers dental services through a dental insurance plan known as Idaho Smiles, and a managed care contractor, MCNA Dental, manages your Medicaid dental benefits.
Idaho Smiles provides the following coverage:
Adults over 21 do not receive coverage for root canals and crowns.
For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Idaho is advisable.
Your Idaho Medicaid health plan covers medications that your doctor prescribes, but some types or brands of prescription drugs require authorization. If one of your drugs requires authorization, your provider or pharmacist will submit the request on your behalf.
Certain non-prescription medicines or items have coverage if ordered by your doctor.
Depending on your age, disability status, and health conditions, you could qualify for the Idaho Medicaid Enhanced Plan. If you’re eligible, you get all the benefits of the Basic plan, and you might be able receive the following additional services:
You typically won’t be able to use your Idaho Medicaid coverage while traveling or visiting another state. Healthcare providers generally can’t bill Medicaid from a different state, but you might be able to find specific providers that accept Idaho Medicaid.
Every state has its own eligibility requirements, and coverage can’t transfer from one state to another. Even if you move to a different state, you have to apply for Medicaid in that state and won’t be able to use your Idaho Medicaid coverage.
If you want to use your Idaho Medicaid plan out of state to cover medical services, you might need prior authorization. However, there is an exception if you require emergency medical care. To qualify for this exception, you must need immediate care and not have enough time to return to Idaho to see your regular doctor. If you are traveling outside of Idaho for leisure, invest in proper travelers insurance.
Idaho Medicaid health plans are available to students and seniors who meet the criteria, including income limits. Students with eligible income, a disability diagnosis, or other special health needs might qualify for Idaho Medicaid coverage.
Adults over the age of 65 who meet the income and resources requirements could qualify for the Idaho Medicaid Enhanced Plan, which includes coverage for things like personal and long-term care services.
Idaho Medicaid long-term care coverage falls under three categories:
Depending on which programs you’re eligible for, you might receive coverage for services such as:
Idaho Medicaid offers programs for specific groups of people that require special healthcare services or support. Certain programs provide services for individuals with household incomes that exceed Medicaid requirements.
The Idaho Medicaid for Workers with Disabilities (MWD) program can help you work and earn money while maintaining eligibility for Medicaid. The income limits are higher to compensate for employment earnings, but you might have a premium to pay depending on your income level.
Here’s an overview of the premiums for certain incomes of individuals who qualify for the MWD program:
Individual applicants must have less than $10,000 in resources, while couples must have less than $15,000.
The Idaho Medicaid health plan has additional programs for children, including:
Some services that Idaho Medicaid covers have limits or require prior authorization. If a service needs authorization, you or your healthcare provider will need to submit a request and provide information showing the service is medically necessary.
The following are some services that might require prior authorization:
Although a burial fund of $1500 may be issued towards the cost of a funeral, considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.
Idaho Medicaid does provide some coverage for those who become injured or ill either in the short or long term. Depending on the nature of the injury or illness, it’s wise to explore disability insurance options to ensure no unnecessary out-of-pocket costs are incurred.
Idaho Medicaid also won’t pay for some services that you get without a Healthy Connections referral. Unless you have exemption, you must enroll for a Healthy Connections primary care provider (PCP) that will coordinate your health services. Some services, such as dental services and pregnancy-related services, don’t require a referral from your PCP.
It can be confusing to determine what Idaho Medicaid does and doesn’t cover, so we provided a list of common services and their Idaho health care coverage eligibility below.
| Dental | |
|---|---|
| X-Rays and Exams | All plans have coverage |
| Wisdom Teeth | All plans have coverage |
| Vision | |
|---|---|
| Eye Exams | Coverage with limits |
| Glasses | Coverage with prior authorization |
| Laser Eye Surgery | No |
| Surgery | |
|---|---|
| Rhinoplasty | Coverage with prior authorization |
| Breast Reduction | Coverage with prior authorization |
| Hospital | |
|---|---|
| Hospital stays | Coverage with limits |
| Ambulance transportation | Coverage with limits |
| Giving birth | All plans have coverage |
| Sexual Health | |
|---|---|
| Gynecologist visits | Coverage with limits |
| Erectile Dysfunction | No |
| Birth Control | All plans have coverage |
| Fertility Treatment | No |
| Specialist Services | |
|---|---|
| Dermatology | Coverage with limits |
| Physiotherapy | Coverage with limits |
| Massage Therapy | No |
| Podiatry and Foot Care | All plans have coverage |
| Allergy Testing | Coverage with prior authorization |
| Sleep Physician Services and CPAP Machines | Coverage with prior authorization |
Idaho Medicaid provides coverage for many health services to ensure individuals with low income can still access quality care. However, the plan generally limits its coverage to services that are medically necessary, leaving out certain procedures that could improve your quality of life. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
If you want to find a cost-effective plan to cover services that Medicaid doesn’t, Insurdinary can make it easy for you. You can browse options from various health insurance providers and compare them all in one place, saving you tons of time and effort.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
