Managed Care Contract & Consulting Services
What Is The Difference Between Medicare And Medicaid?
Medicare – is a federal program that provides health insurance coverage to people who have disabilities, are diagnosed with certain medical conditions, or are the age of 65 or older.
~ Medicare has three basic coverages: Part A, Part B, and Part D.
○ Part A pays for hospitalization costs
○ Part B pays for physician services, lab and x-ray services, durable medical equipment, outpatient, and other services. ○ Part D provides coverage of prescription drug costs.
Because Medicare is run by the federal government, its coverage, rules and regulations are basically the same everywhere in the United States. The program is run by the Centers for Medicare & Medicaid Services.
Medicaid – is funded jointly by the federal government and the states, and provides health care coverage to low-income people who meet specific requirements for income and other eligibility criteria. Medicaid covers individuals who cannot otherwise afford insurance.
The Financial Alignment Demonstration project is to transition dual eligible Medicare-Medicaid patients into managed care. It is a 3 year pilot program, an initiative that brings cost savings for Federal and State governments. Is your state participating in the FAD? What is the current status? Check here.
What are Dual Eligibles?
Dual Eligibles – Patients that qualify for both Medicare Part A and/or Part B and are eligible for Medicaid benefits (Also known as Medi-Medis or Duals). ~ This went into effect on September 1, 2013.