Medicaid & Medicare Billing

For patients without private insurance who qualify for Medicare, Congress designed Medicaid to help cover services and costs not covered by Medicare. In most cases, health care providers and third-party medical billing companies will bill Medicare first, because it's the primary payer, and they will bill Medicaid second.

Significance

• Health care providers and third-party medical billers will bill Medicare first for such things as hospital care, doctor's visits, nursing facility care and home health care. Often Medicare will not cover all health care costs, so health care providers will bill Medicaid for any remaining costs.

Features

• Medicare is designed to cover short-term or emergency health care. Medicaid is used to cover long-term care such as nursing home care. For this reason, Medicaid is typically stricter with medical billers than Medicare is, and Medicare covers a smaller range of health care services.

Considerations

• Medicaid is used for longer term care. Medicare will also cover long term care but is typically more strict with its coverage. For example, Medicare covers care in a nursing home but only for a limited number of days. After that, Medicaid will cover additional services.