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Running head: QUALIFICATIONS 1 Qualifications to Receive Medicare and Medicaid Ashleigh Holomon Aspen University Author Note Healthcare Policy and Economics Dr. Heather Bailey, DNP, RN, CNE March 2, 2020
2 QUALIFICATIONS Qualifications to Receive Medicare and Medicaid Medicare and Medicaid are usually seen together and can be sometimes confused about which program covers what. Both of these programs are not alike at all but completely different. Medicare will guarantee health insurance of all Americans over 65 years old. Medicaid is a program for low-income Americans that provide health coverage. Some with certain disabilities and the elderly can also receive these programs. Both the federal government and the States finance them. The population of these programs is growing very rapidly. Medicaid is pretty expensive. It is covered over 65 million persons for $421 billion which covered by federal, state and local governments. Medicaid it’s the largest of the state budgets, and enrollment expands when the economy contracts (Nickitas, Middaugh, & Aires, 2016). Medicare with Medical Billing When it comes to billing for Medicare things are done a little bit differently than someone with Private pay or insurance through their employer. The claims are sent straight to Medicare, similar but different in other ways. Each claim is evaluated and this can take up to a month since the claim is sent to a contractor employed by Medicare. Medicare Part A, Part B, Part C, and Part D all have different parts. The most significant effect Medicare has on billing is that reimbursement rates for services are set by Medicare and are typically less than the amount billed or the amount that a private insurance company would pay (Norris, 2018). If the claims are sent to billers for Part C and D then it will be a more complicated process. Billers cannot custom

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