At first glance, Medicare and Medicaid might seem like twins, or a dynamic duo, or two peas in a pod—basically, inseparable. They’re both government healthcare programs; they were both created at the same time; they’re both confusing and usually don’t boast the best reimbursement rates, and they even sound alike (they both start with “Medi-,” right?).
In reality, though, these two programs are very, very different. For starters, Medicare is a federally run program, which means it has a uniform set of rules that apply across the entire country. Medicaid, on the other hand, is state-based, meaning the program is a mix of rules and requirements that vary from state to state. So, the Medicaid rules in Texas aren’t necessarily the same as those in California or New Jersey. And that’s only the beginning! With that in mind, let’s discuss some major billing and reimbursement differences between Medicaid and Medicare.