A Guide to the Alaska Medicaid Insurance Plan

Applying for Denali Care

You have several options available to you by which you can submit an application for Denali Care. The most popular method for submitting a Denali Care application consists of downloading, printing, and filling out an Application for Services (GEN 50C), then submitting it by way of either fax, mail, email, in-person, lobby dropbox, direct secure messaging. You can also apply over the phone by calling the Virtual Contact Center at (800) 478-7778, an option that may work better if you have questions about filling out the application properly.

If you prefer to apply online, you can do so by visiting the Alaska Department of Health - Division of Public Assistance.

Before submitting an application, gather any necessary information that can help you prove your eligibility for Denali Care. Examples of what you might need include:

• Birth dates
• Social security numbers
• Document numbers for legal immigrants
• Current health insurance information and policy numbers
• Work and income information for the entire household, including W-2s and pay stubs
• Information about health insurance available to your family through a family member’s employer

Eligibility Requirements

To apply for Alaska Medicaid and acquire a Denali Care card, you must reside in Alaska permanently and prove that you’re an American citizen, national, or non-citizen with legal admission. Other eligibility requirements include expectant mothers, children 18 years old or under, or a primary caregiver for a child of that age. If you have insurance through your workplace, a private plan, or from a parent or guardian, you may not qualify for Denali Care.

If you do have insurance through an employer, or have coverage through Tricare or Medicare, you may still qualify for Medicaid depending on life or financial circumstances. Alaska issues Denali Care for families of certain sizes with a particular annual household income maximum. If you exceed that maximum, you cannot qualify for Alaska Medicaid. The income limit to receive the benefits are:

• $2,069/month if you are single
• $2,792/ month as a couple

There are also additional income limits, for example if you are a senior, are in need of a nursing home, blind or disabled. Please refer to this page for additional details and maximum income eligibility amounts. As coverage for certain types of disabilities may be limited under the Alaska Denali Medicaid plan, many people secure more comprehensive benefits by investing in additional disability insurance.

When you use Denali Care in addition to other insurances, Denali Care serves as the “payer of last resort”. This means that Denali Care will only cover anything not already covered by your other insurances.

Getting a Denali Care Card

To obtain a Denali Care card, you must first apply for Alaska Medicaid through the methods described above. After your original application, it may take up to 45 days before you receive a response. If approved, you’ll receive your card and information in the mail, but if not approved, you’ll receive a letter explaining why you didn’t get approved and what steps you can take next.

While waiting for your approval letter, you may have situations arise where you need medical care right away, such as a sick child or pregnancy-related difficulties. In these situations, seek the medical attention you need, but call the Virtual Contact Center at (800) 478-7778 and request they prioritize your application.

Renewing or Replacing Your Denali Care Card

In most cases, benefit recipients must complete and submit their renewal application by the fifth of the month during which benefits will end. This annual renewal, performed correctly, will ensure that coverage continues for another year so long as they continue meeting eligibility. Failing to submit the renewal application on time can induce a gap in coverage and delay your renewed benefits as well.

If you need to use your benefits during a coverage gap due to late renewal, you can contact your Public Assistance office regarding the situation.

For pregnancy, postpartum, and newborn baby coverage, Denali Care renewals have different requirements than the normal method. New mothers covered by Denali Care before their birth retain the insurance for 60 days after the child’s birth, during which she can apply for continued coverage at the 60 days.

Newborn babies require the parents to notify Denali Care of their child’s birth, after which the baby receives coverage for the first year of their life. To continue the coverage, the parents must submit a renewal application before the child turns one.

It’s not unusual for insurance cards to become damaged or lost, and Alaska Medicaid understands that. If you lose your Denali Care card, contact the Virtual Contact Center to request a replacement. There is also the option of sending the Alaska Department of Health an email to begin the process of replacing or renewing your card.

Denali Care Coverage

Alaska Medicaid covers a wide variety of medical services. To qualify for coverage by Denali Care, medical procedures, prescriptions, etc. require medical necessity. Voluntary or cosmetic procedures typically will not fall under Denali Care’s jurisdiction if they do not somehow affect the patient’s quality of life physiologically. When considering a medical procedure that you don’t know Denali Care will cover, you must discuss the potential of coverage with your medical provider. Any services that you attempt to apply your Denali Care to that Medicaid does not cover require you to pay for them yourself.

Dental

Denali Care covers many child, adult, and elderly dental services, including emergency dental services intended to relieve the patient of infection or pain. For non-emergency dental procedures, adults have coverage up to $1,150 each year. For eligible Alaskans, it’s advised to first check to see if the dentist you intend to visit accepts Medicaid. To make sure you actually have coverage for your dental procedures, discuss what dental needs you have and ensure that your dentist obtains a service authorization before the appointment. This step will help you avoid unexpected dental expenses because Denali Care refused to cover it.

For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Alaska is advisable. Some preventive and restorative services covered by Denali Care include:

• Crowns
• Dentures
• Root canals
• Dental exams
• Annual cleanings

For children under the age of 21, Denali Care covers a variety of dental services including:

• Caps
• Crowns
• Scaling
• Sealants
• Dentures
• Polishing
• Root canals
• Dental exams
• Dental X-rays
• Fluoride varnish
• Tooth restoration
• Pain and infection relief

Denali Care will also cover oral surgeries and necessary orthodontic treatments, including braces intended to correct a bite and make eating and speaking more comfortable. While most of these procedures fall under automatic coverage, you should ensure that your child’s dentist obtains a service authorization if the procedure may not have automatic coverage.

Prescription Drugs

Denali Care covers most prescription drugs for children and adults. If a prescription requires special authorization, your medical provider and pharmacist will take care of that for you. If your doctor prescribes an over-the-counter medication to you such as prenatal vitamins or laxatives, Denali Care may cover those as well.

Expectant mothers and children prescriptions don’t have a co-payment, while adult patients must pay a co-pay depending on the cost of the drugs. A prescription costing less than $50 requires a $0.50 co-payment, while drugs above $50 cost $3.50. Patients with Tricare or a form of coverage from an Alaska Native Tribal entity often won’t have a prescription co-pay. The Denali Care drug program provides a list of approved prescription drugs. That list can be found here.

Should you have another insurance plan that offers prescription coverage, you must report that to Denali Care. You should also update Denali Care if your other prescription coverage ends. If you do not disclose other prescription coverages to Denali Care, you may experience a delay in filling your prescription.

Extended Health Care

Rehabilitation services, nursing facilities, and home care often require long-term aid. Denali Care alleviates these health costs and covers many aspects of extended health care. From senior services like living in a nursing home or having an in-home nurse may fall under the umbrella of Denali Care.

Alaska Medicaid requires individuals to meet certain criteria to qualify for extended health care, such as having a proven developmental or intellectual disability. Denali Care may also approve service authorizations for elderly patients requiring a stay in a long-term health care facility.

Before approval occurs, Medicaid considers specific factors for approval of care, including:

• What level of care the patient will require
• The patient’s mental and physical stability
• What qualifications the patient’s caretakers have
• The length of time the patient must stay in the facility

If a patient requires transfer to another facility or admission to a different facility, Denali Care must approve it. Additionally, once the patient outlasts the original service authorization, they must reapply for a new one to continue service.

Travel and Out-of-State Coverage

If you need to visit specialist health care providers or require a covered procedure not available in your area, your doctor may refer you to someone in a different community. When this happens, Denali Care may cover your travel so long as your situation meets specific criteria including:

• Medicaid must approve the medical services.
• The medical services must not exist in your area.
• You must get approval for traveling and book travel through Medicaid.

Denali Care understands that traveling for medical needs requires much consideration and has guidelines to help you throughout your medically-required travel. Alaska Medicaid offers travel vouchers for meals and taxi services strictly related to your medical needs. In addition, Denali Care may cover plane tickets and hotel rooms.

The best way to ensure a good experience traveling for medical necessity with Denali Care consists of maintaining communication with the Medicaid Travel Offices. You’ll need pre-authorization to travel, and the offices that help you schedule travel and lodging can also help you when you have changes in your itinerary.

In the case that you miss transportation or otherwise interrupt the approved itinerary, Denali Care may cancel the rest of your itinerary if you don’t contact them as soon as possible.

On the other hand if you are traveling out-of-state for leisure and you require medical attention, chances are your Alaska Medicaid won’t cover your expenses. In some cases, if heaven forbid a life-threatening emergency occurs, Denali Care may kick in, but this is on a case-by-case instance. If you are traveling outside of Alaska for leisure, invest in proper travelers insurance.

Students and Seniors

Students age 21 or younger can use Medicaid so long as they meet certain criteria. If they carried Alaska Medicaid over from their time as a dependent in their parents’ household, they must report their own income and insurance eligibility. Having too high of an income may disqualify them, while having another insurance simply pushes their Medicaid into the “payer of last resort” position.

Seniors age 65 and higher can qualify for Alaska Medicaid and use Denali Care for their medical services and long-term care. Some covered services for seniors can include:

• Audiology
• Physical therapy
• Occupational therapy
• Speech-language pathology
• In-home part-time nursing services
• Medical equipment and supplies kept in the home

For seniors needing long-term care in their home or in a hospital for end-of-life stages, Denali Care can cover some hospice care services. This includes general inpatient or at home nursing and care services.

Coverage for Subgroups

Denali care offers Medicaid for subgroups the same way it offers medicaid to every other eligible person in the state. The discussion below outlines coverage for Aboriginals and Military personnel.

Aboriginals

Alaska Natives or American Indians can take advantage of Denali Care so long as they meet the same criteria required by non-Native patients. Medical insurance resources for Natives operate as normal with Alaska Medicaid, though some changes in their plans do occur, including no co-payment required for prescription drugs.

To maintain Denali Care in addition to their Native health coverages, Alaska Natives or American Indians must work with Indian Health Services to guide them through Medicaid.

Military

Military families who meet the required criteria can apply for and receive Denali Care. Their Tricare insurance will take precedence for every procedure while Denali Care coverage applies to whatever amount remains. In order for military veterans to receive eligible benefits, it is advised to apply through veterans affairs.