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Medicare vs. Medicaid Reimbursement Rates: All You Need to Know

Medicare vs. Medicaid reimbursement rates

Medicare and Medicaid are state-owned programs providing health insurance to aged and low-income families. We know how insurance helps us by paying for healthcare costs but did you ever wonder how the process works? Or how are the providers reimbursed for their payments? In this blog, we’ll highlight the comparison between Medicare vs. Medicaid Reimbursement Rates are bridge your knowledge!

Medicaid vs. Medicare: The Basics

Medicare is a state-regulated program for individuals aging 65+ or with a disability. Once you meet the eligibility criteria, you can get Medicare, regardless of your income level. On the other hand, Medicaid is a state and joint federal program providing health insurance to low-income families.

Although income eligibility varies with State, the basic rule is that legal residents of the US with income 138% below the poverty line can qualify for Medicaid. Moreover, depending on the eligibility criteria, you can have both Medicaid and Medicare.

Now that you have a basic know-how of both the programs let’s delve into the reimbursement rates criterion.

Medicare vs. Medicaid Reimbursement Rates

Although the billing lists and rates are uploaded on the official website of Medicare and can vary with State, we’ll tell you about the basic reimbursement model.

Medicare Reimbursement Rates

Original Medicare has Part A and Part B, and the company pays 80% of the total costs after you meet the deductibles. Part C includes Medicare advantage plans which unify and often include prescription medication coverage (Part D).

Moreover, if you’re social security recipient, your premiums restrict from rising under the Medicare hold harmless provision ruling.

The funds’ sources of Medicare include payroll taxes and Medicare payments such as premiums, deductibles, copays, and coinsurances. The State reimburses doctors, hospitals, and insurance companies from this trust.

Each year, the reimbursement rates for Medicare get updated in the final annual release, and providers are moving towards value-based models where payment is based on the patient and quality of care.

In most cases, the care providers file the claim to reimburse payments themselves, and it’s not your obligation. However, exceptions exist in the case of treatment from a non-participating provider or foreign treatment.

Medicaid Reimbursement Rates

Although the reimbursement rates for Medicaid are low, they vary according to State. Usually, Medicaid pays providers 72% of total Medicare rates. Since the payment is low, physicians are reluctant to participate in a Medicaid program.

The State pays providers on a fee-for-service model agreement. However, Medicaid providers are also shifting to a Value-based model where fees charge according to the person. Furthermore, you don’t have to worry about filing claims because the State is responsible for reimbursing payments to the provider.

Medicare and savings account

Although you can have a Medicare savings account, since it requires an HDHP plan, you cannot contribute further to the account and only withdraw existing funds from the account.

Parting Thoughts!

Till now, you should have a clear distinction between Medicare vs. Medicaid Reimbursement Rates. If you’re looking for affordable coverage, get quotes from New Medicare and accept Medicare state programs that suit you.

Reach out today.

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