So, what is the difference between Medicare & Medicaid?

2011-10-26T00:57:00.000-07:00

So many people, even in healthcare, don’t know the difference between Medicare and Medicaid. It seems odd to me this difference isn’t taught in the education of those in healthcare. But, maybe that’s why the industry has people like me (nerds) that work alongside those providing care.

Most people know the basics about Medicare. I abbreviate Medicare as MCare. Anyway, MCare is a Federally funded program that pays a portion of the healthcare of the seniors in the country. In certain situations, people younger than 65 may be able to enroll in MCare. But, for the most part, MCare is reserved for individuals in retirement that are over 65.

MCare has 3 parts to it…well, actually four parts. There’s Part A, Part B, Part C and Part D. These parts were created when each of the parts were passed by the legislature. A future blog post will go over the four pieces of MCare. Anyway, when you are a MCare enrollee and you need to see a doctor or go to the hospital, you can present your MCare card and any benefits afforded to you will be covered. Your hospital or doctor will receive a payment from MCare through that’s called a fiscal intermediary (FI). These are organizations that MCare’s parent government agency (the Center for Medicare and Medicaid Services, aka: ‘CMS’) contracts with to pay claims for care rendered to MCare enrollees.

So, that’s a basic blurb on MCare:

· Federally funded

· Has 4 parts (A, B, C and D)

· Pays benefits to enrollees through a fiscal intermediary

· Administered by CMS.

NOTE: Do not confuse this type of MCare with a MCare Advantage plan. This will be covered in a later blog post.

Medicaid, on the other hand, has some differences to it. I abbreviate Medicaid as MCaid when I write. Anyway, MCaid is funded in part by the Federal government. But, it is also funded to a large degree from the State the MCaid enrollee resides. Most States have enrollment criteria that individuals must meet to be enrolled on MCaid. For instance, MCaid may provide care in the following situations:

· Infant care (this can be known as the Childs Health Insurance Plan, or CHIP)

· Health insurance for the disabled where there is no other health care available

· Healthcare for the poor

Typically, once an individual is on MCaid the State that enrolls that individual assigns them to a Healthplan at administer their benefits. In some situations, the patient enrolled in a States MCaid may choose the healthplan they are to use. States like to contract with healthplans to administer the MCaid benefits because it is cheaper for the States to pay a company to do it rather than for the States to do it themselves. Some would argue it’s better that way…that way a State bureaucrat isn’t making healthcare decisions for MCaid members.

MCaid programs still receive Federal funds and CMS has some oversight, but the States hold the majority of the financial burden for the care provided to its citizens.

So, that’s the basic blurb on MCaid:

· Funded by the State and Federal government

· Once enrolled it’s benefits are administered by a health plan

· Has ‘sadder’ enrollment criteria (disability, chronic serious conditions, poor, etc.)

· Administered by the State rather than CMS

In the next blog I’ll talk about the different types of MCare programs.

Doug's Healthcare & Social Blog

So, what is the difference between Medicare & Medicaid?