Medicaid Costs and Coverage in Virginia


“How much is Medicaid in Virginia and what does it cover?” is a frequent question asked by Virginia residents in need of medical coverage. While Medicaid cost estimates often vary depending on several factors, many services are available to qualifying recipients at no charge. However, Medicaid coverage, also known as medical assistance in Virginia, may require a small copayment for certain types of services. Since medical assistance coverage is only available to low- or very-low income Virginia claimants who fall under a specific covered category, Medicaid costs are typically very affordable. Furthermore, various types of Medicaid insurance policies cover different types of medical services. For instance, Medicaid insurance for pregnant women includes prenatal and dental care during the term of the pregnancy, while coverage for aged, blind or disabled groups include benefits such as hospital, doctor and pharmacy services. To learn more about what services are covered by Medicaid and to obtain medical assistance cost estimates, potential enrollees can download our comprehensive guide. To learn more about the various types of VA Medicaid insurance benefits available to state residents, Virginia residents can review the information below.

What services are covered by Medicaid in Virginia?

State residents may ask, “How much does Medicaid cost in Virginia and which services are covered under a standard policy?” when reviewing affordable health care options. In Virginia, Medicaid cost estimates and coverages vary by group type and benefit level. Covered groups that meet eligibility conditions for Medicaid benefits in VA typically include low-income pregnant women, families and children (F&C), medically needy petitioners who meet covered group requirements, certain Medicare beneficiaries and aged, blind or disabled (ABD) claimants. For instance, Medicaid coverage benefit levels for ABD groups include full benefits, time-limited coverage and the Medicare Savings Program. With full Medicaid insurance, patients receive extensive benefits such as pharmacy, hospital and doctor services, while those with time-limited coverage only qualify for temporary assistance if they meet a financial spenddown. Furthermore, the Medicare Savings Program is available to lower-income Medicare recipients who wish to obtain additional medical assistance through the Virginia Medicaid program.

Like ABD Medicaid coverage in VA, there are benefit levels for F&C groups completing the Medicaid application process. These types of Medicaid coverage levels include full or time-limited benefits. However, Medicaid insurance in VA covers most essential medical services, including inpatient and outpatient care, behavioral health, pharmacy services and professional visits such as physical or occupational therapy. However, patients may need to obtain prior authorization for certain types of care services. Furthermore, certain types of Medicaid insurance in Virginia can include additional coverages options. For instance, Medicaid insurance coverage may include prenatal and maternal care, home health services, long-term care, organ transplants, prosthetic devices, rehabilitation services, nicotine replacement therapy for pregnant women, and free enrollment in the early and periodic screening, diagnosis and treatment program (EPSDT). Through the EPSDT program, for instance, beneficiaries 21 years of age and younger receive regular medical, vision, hearing and dental check-ups, along with free diagnoses and treatments.

Before learning how to apply for Medicaid, applicants should explore the different types of coverage options to see if Medicaid is right for their family. Depending on the specific type of Medicaid coverage claimants are eligible for, they may receive dental care services as well. For instance, Medicaid coverage for F&C groups include dental care for children and necessary oral procedures for adults who are 21 years of age and older, under certain conditions. Additionally, coverage for ABD groups can include medically necessary dental services for adults older than 21 years of age.

What does Medicaid not cover in Virginia?

While Virginia Medicaid coverage provides qualifying recipients with essential healthcare benefits, many services are not covered under the state’s medical assistance program. For instance, many types of Medicaid insurance policies do not include chiropractic care, acupuncture, cosmetic surgery, unauthorized hospital stays, personal care, private duty nursing, weight loss clinics and dentures, eyeglasses, immunizations for recipients older than 21 years of age and many other services. When learning how to apply for Medicaid coverage, it is important that enrollees understand the types of services covered through the program to avoid applying for a program that does not suit their family’s medical needs.

How much is Medicaid in Virginia?

Virginia Medicaid cost estimates vary depending on several factors. For instance, the estimated cost of Medicaid varies by covered group type, the age of the beneficiary and household income. However, the cost of medical assistance is generally very low. While claimants with Medicaid coverage generally receive medical care free of charge, some members may need to pay small copayments when they receive certain types of services. However, children who receive assistance through this program are not responsible for making copayments, regardless of the type of service they wish to receive. Additionally, residents with Medicaid benefits in VA are exempt from making copayments if they participate in a hospice program or receive community-based long-term care services. Furthermore, there are no copayments for emergency services, dialysis treatments, family-planning or pregnancy-related services and emergency room visits. If residents with Medicaid insurance coverage are responsible for making a copayment but cannot afford to do so, however, the medical provider cannot refuse to treat them.

To obtain additional Medicaid cost estimates in Virginia, click here to download our comprehensive guide.

Virginia Department of Social Services