Medicaid Costs and Coverage in Florida


“How much is Medicaid in Florida?” is a common question asked among those interested in applying for healthcare benefits. With the growing number of Floridians struggling with low-income jobs, disabilities, or merely old age, these patients need Medicaid coverage more than anyone else in the country. However, Medicaid coverage in Florida comes at a cost. There are billions of dollars spent each year on Medicaid coverage in Florida. Since more Floridians are applying for Medicaid coverage each year, this means more money is being taken out of the state and federal budgets. There are also multiple types of Medicaid insurance that have varying costs associated with them. It is important for potential Medicaid recipients to understand what kind of medical services are offered with the Medicaid coverage they are interested in getting for themselves or for their families. This will allow future beneficiaries to figure out what services are covered by Medicaid. To learn more about Medicaid costs and coverage in Florida, review the following topics:

  • Medicaid Coverage Costs in Florida
  • Florida Medicaid Services
  • What Medicaid Does Not Cover in Florida

Medicaid Coverage Costs in Florida

Medicaid coverage in Florida assists qualifying patients with their medical costs, but in many cases, not all of them. Each of the types of Medicaid insurance is issued to the participant based on his or her income level, level of need and age. For example, FL Medicaid coverage may be used to cover the costs of premiums and services required of a participant in the Florida Medicare program. Qualifying participants can have the deductible that is required by Medicare covered by the Medicaid policy. However, Medicaid coverage requires that participants meet a certain dollar amount each quarter (every three months) in order to be covered. If that share-of-cost is not used, then the amount is lowered.

As with Medicare, Medicaid coverage is offered to participants through several different managed care plans. Each health plan is different in what types of medications are covered (called formularies), and how much the plan will pay for routine visits to the doctor. As with any type of health insurance plan, it is important to compare those that are available. Not all doctors who accept Medicaid will accept all Medicaid plans, so it is important to inquire with the personal care physician to find out which Medicaid plans he or she prefers.

In order to maximize Medicaid coverage in Florida, it is best to keep accurate records of the healthcare expenses, and if possible, to make all appointments and medical expenses for earlier in the month, which should help in meeting the patient’s share-of cost-amount. Keeping a running total of the healthcare expenses each month will assist the participant in making certain that the share-of-cost is met. Any healthcare expenses that are more than 90 days old and were incurred prior to being on Medicaid will not be covered. Many participants receiving Medicaid coverage do not realize that there is very little in out-of-pocket costs that must be paid, as once the share-of-cost amount is reached, Medicaid will pay for the expenses. To learn more about out-of-pocket costs and share-of-costs amounts as they relate to Florida Medicaid, download our guide.

Florida Medicaid Services

What services are covered by Medicaid in Florida? Since there are different types of Medicaid insurance, the exact services that someone gets will vary based on his or her particular Medicaid coverage plan. There are certain factors that also go into how much Medicaid coverage a person receives. Age, for example, is one factor, because older recipients will obviously need more Medicaid coverage than younger beneficiaries. However, most types of Medicaid insurance in Florida will cover services like doctor visits, hospital visits, dental services, vision services, prescription drugs and child health checkups. Older recipients may also get Medicaid coverage for nursing home services, community-based services, home-based services, home healthcare and transportation to get medical care services and hospice services. Pregnant women also have specific services covered by Medicaid, which can be reviewed by downloading our free guide.

Florida Medicaid coverage does entitle elderly recipients to a Home- and Community-Based Services program, which is funded by the federal government. This program basically pays for most in-home services that a recipient may need. This special type of Medicaid coverage pays for personal care services, adult day care services, home health aide services, case management, respite care services and habilitation.

What Medicaid Does Not Cover in Florida

What does Medicaid not cover in Florida? After understanding what services are covered by Medicaid, it is simpler to understand what Medicaid does not cover. Many patients assume that Medicaid coverage will afford them the luxuries and amenities that are indirectly related to their health. However, Medicaid coverage only pays for services that are vital for the well-being of the recipient. For example, Medicaid coverage does not pay for a private room in a medical facility, except if the recipient requires it for medical treatment. Recipients also cannot use Medicaid coverage to pay for specially prepared food, cosmetic services, grooming services, personal items, personal clothing, tobacco products, televisions, computers, telephones and other comfort items. There are types of Medicaid insurance that will cover special care services, but they must be necessary for the treatment of the recipient. Just remember that Medicaid coverage only applies to whatever is medically necessary to the wellbeing of the patient. If something is not deemed medically necessary, then Medicaid coverage cannot be applied.

What Assistance Benefits Does the Department of Children and Families Provide?

Various assistance benefits are available to residents of Florida through the Department of Children and Families (DCF). Families can receive benefits that allow them to buy nutritious groceries, save money on school lunch for their children and obtain temporary financial assistance. Additionally, petitioners who qualify for one assistance program are also typically eligible for other benefits in Florida. Find out how to qualify for benefits through Florida’s DCF and how to apply for them by downloading our comprehensive guide.

Who Can Receive Assistance Benefits in Florida?

Each assistance program offered through Florida’s Department of Children and Families has various eligibility qualifications that petitioners must meet in order to enroll. Household size and income are only a few factors that are typically taken into account. For more details on eligibility for Florida DCF assistance programs, download our guide.