Are Medicare And Medicaid Reimbursement The Same?





Are Medicare And Medicaid Reimbursement The Same?

To simply answer the question, no. While the two have similarities, there are some differences.

What Is Medicare Reimbursement?

Medicare reimbursement is the term that refers to payments hospitals and doctors receive as a result of services provided to patients that are covered under Medicare. The money or reimbursement goes to the billing provider. Doctors can choose to accept the rate that Medicare has set for the services they have provided. Medicare pays 80 percent of these costs. Doctors have the option to participate or not. Some opt not to because it is not profitable to them.

What Does This Mean To Me?

Simply it means that patients need to ask if their doctor is a Medicare participate. It also means that the patient will have to pay the remaining 20% that was not reimbursed to the doctor. For example, if the total cost for a test the doctor has ordered is $100, Medicare would pay $80, leaving the remaining $20 for the patient to pay.

What Is Medicaid Reimbursement?

Medicaid reimbursement is similar to Medicare reimbursement in that payment goes to the provider. The major difference from Medicare reimbursement is that doctors who chose to be Medicaid providers are required to accept the reimbursement provided by Medicaid as payment in full for the services provided.

What Does This Mean To Me?

While this may sound like good news, some doctors do not accept Medicaid for this very reason. Asking questions beforehand is the best thing a patient can do. Being prepared and asking questions to your medical provider in advance can help make life a little less complicated.



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