Can Medicaid Patients Pay Cash? Out-of-Pocket, Self-Pay Detailed

patient paying doctor with cash

Short Answer

Medicaid patients are often responsible for out-of-pocket costs like copayments and spend-down deductibles, and you may be able to pay these amounts in cash if your care provider accepts it. Sometimes, you can save money by paying fully out-of-pocket for health care services, and providers may accept cash for self-pay as well.

Can Medicaid Patients Pay Cash?

Medicaid is a joint federal-state health services program for low-income adults, children, pregnant women, elderly adults, and people with disabilities.[1]

Payment arrangements for out-of-pocket Medicaid costs are determined by the individual state and the entity providing care.[2]

You may be able to pay these costs using cash, a personal check, a credit card, or a debit card, depending on what your care provider accepts.

In some instances, you may decide to self-pay — or pay directly out-of-pocket for health care — which might be cheaper than your Medicaid deductible or copay. Your provider may also accept cash in these instances.

Paying Medicaid Out-of-Pocket Costs

Your enrollment in Medicaid and the amount you pay out of pocket are determined by your Modified Adjusted Gross Income (MAGI), your medical status, and your state of residence.

States set the rate for each service and can require income-based copayments, coinsurance, deductibles, and other charges for both inpatient and outpatient services. There are, however, maximum copayment amounts that providers can charge.[3]

Not all Medicaid enrollees pay out-of-pocket costs; those in greater poverty will pay lower co-payments.

There are also circumstances and population groups for whom out-of-pocket fees will not be assessed. These include:[4]

  • Emergency services
  • Family planning services
  • Pregnancy-related services
  • Services for children
  • Services for terminally ill individuals
  • Services for individuals living in an institution
  • Hospice patients
  • Those who have received services from the Indian Health Service or tribal health programs
  • Those enrolled in the Breast and Cervical Cancer Treatment Program

It’s important to note that for Medicaid patients, providers cannot withhold services if you can’t afford your copayment, but you will likely still be held liable for any unpaid copayments.[2]

Spend-Down Medicaid Services

If your income exceeds the poverty level, you may still qualify for Medicaid if you spend the excess income amount on medical expenses.[5]

This out-of-pocket cost is known as a spend-down amount or a deductible, and you must report payments toward this required contribution to Medicaid before your enrollment is active.

After you’ve spent down the excess income on medical bills, your Medicaid enrollment will activate and cover the rest of your medical expenses.[6]

Note: Medical providers can bill patients and even take debt collection measures while the patient is not yet an active Medicaid enrollee.

Saving Money With Self-Pay

Choosing self-pay sometimes means withholding your insurance information, including Medicaid.

If you have a high-deductible insurance plan, it may be cheaper for you to negotiate with your provider and pay directly, instead of leaving the negotiation to your insurance company.[7]

This can be especially applicable to basic procedures like x-rays, CAT scans, ultrasounds, therapy services, lab work, and prescriptions.[7] Some providers and companies even provide discounts to patients who choose to self-pay.

Most medical providers won’t show you their different pricing options before letting you decide whether to bill your insurance or not, though facilities that cater to self-pay patients may be more open to negotiation.

States have the right to establish self-pay costs,[3] which may be higher or lower than your Medicaid spend-down or copay for a specific service.

To find out the difference in price, you can tell your provider that you plan to pay for the procedure yourself. You can then discuss pricing and accepted payment methods to find out if you are able to pay in cash.

You can also ask if there are any discounts available to patients who self-pay, as these may not be advertised outright.

The main thing to keep in mind when you’re looking to take advantage of self-pay options is that if you choose to withhold insurance information to secure a cash rate, the payment won’t apply to your policy’s spend-down or annual out-of-pocket spending limit.

For more about Medicaid, see our related article about using Medicaid at Walmart.

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