Navigating Medicare and Medicaid: A Guide to Government Payer Medical Billing


History of Medicare & Medicaid
Medicare was first established in 1965. It is a federal health insurance program primarily designed for individuals aged 65 and older. It also covers younger individuals with disabilities and those suffering from specific medical conditions. These conditions specifically include end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS). The program is administered by the Centers for Medicare & Medicaid Services (CMS). This program consists of four major parts that have been discussed below comprehensively. Each program addresses specific healthcare needs and targets patients.

Medicaid is a Program for Low-Income Individuals. It is a joint federal and state program that provides health coverage for individuals with low income and limited resources. Although the federal government has already set guidelines and regulations, each state administers its own Medicaid program as per the needs of its population. Medicaid is considered a primary program that serves various demographics. It specifically serves low-income adults, children, pregnant women, elderly individuals, and all other people with disabilities. By and large, it can be said that it serves almost every single individual in the country.

Four Parts of Medicare
1. Medicare Part A ─Hospital Insurance
Medicare Part A provides coverage for inpatient hospital stays. It also covers skilled nursing facility care, hospice care, and some home healthcare services. It is funded through payroll taxes, and it covers eligible individuals automatically when they turn 65 years old.
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