Tuesday, March 1, 2011

Medicare and Medicaid general information


This section includes general information about the Medicare and Medicaid Programs, comparisons between them, and how they relate to one another in cases in which an individual has concurrent entitlement to medical care benefits under both programs.

• Both Medicare and Medicaid are part of the Social Security Act.

• Medicare is an insurance program designed and administered by the federal government. Medicare is also called Title XVIII (18) of the Social Security Act. Medicare services and rules for payment are the same for all states in the United States. Applications for this program can be made at local Social Security Offices, which can also provide some details regarding services.

Medicare claims are processed by federally contracted private insurance organizations called carriers and intermediaries located throughout the U.S.

• Medicaid is an assistance program that is a federal-state partnership. Some services, as established by the federal government, are required to be provided. Additional services may be provided at the option of individual states. Medicaid is also called Title XIX (19) of the Social Security Act. Each state designs and operates its own Medicaid Program within federal guidelines; therefore, programs vary among states. In Missouri, an individual may apply for Medicaid benefits by completing an application form at a Family Support Division (FSD) office. Each county in Missouri has an FSD office.

In Missouri, Medicaid claims are processed by a state-contracted fiscal agent that operates according to the policies and guidelines of the Division of Medical Services within the Department of Social Services, which is the single state agency for the administration of the Medicaid Program.

• For recipients having both Medicare and Medicaid eligibility, the state Medicaid Program pays the amounts indicated by Medicare to be deductible and/or coinsurance due on the Medicare allowed amount. These payments are referred to as “Crossovers."

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