What You Pay
Most people who get Medical Assistance (MA) don’t have to pay a monthly premium. If you are covered by MA, 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 a small $3.20 monthly deductible and small copayments that range from $1 to $3 when you use certain medical services that MA covers.
Note: If you are not able to pay a copay or deductible, your medical provider still has to serve you. Providers must take your word that you cannot pay. Providers cannot ask for proof that you cannot pay.
There are some people who do not need to make copayments:
- Children less than 21 years old
- Pregnant women
- People in hospice care
- Refugees
- People in nursing homes or Intermediate Care Facilities for Persons with Developmental Disabilities (ICF-DDs)
Dahlia is on MA and never has to pay a monthly premium. One chilly day in early November, she feels sick and bundles herself up to go to the doctor. When she gets there, the doctor tells Dahlia that she has a bad cold and prescribes her a medication.
Since this was Dahlia’s first usage of her MA coverage in November, she has to pay the $3.20 deductible. She also has to pay a $3 copay for the visit and a $1 copay for the medication.
Her total cost for the visit is $7.20. If she visits the doctor again in November, she will have to pay her copayments again, but not the $3.20 deductible.
Retroactive Coverage
MA allows new enrollees to request coverage retroactively. This means that you can ask to have your MA coverage begin three months before the month you apply. So if you enroll in MA in April but have unpaid medical bills from the previous three months (January, February, and March), you could have MA pay for those unpaid bills.
Compared to Private Insurance
MA’s deductible and copayments are much lower than the copayments required by private insurance plans. For example, manyprivate insurance plans can have annual deductibles that require you to pay thousands of dollars before the plan will cover most services and even after the deductible is paid, many private insurance plans require $50 or more copayments for services.
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