Should I Enroll in Medicaid or Medicare?

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As a health care provider, you must decide in which health care plans you will enroll. From commercial insurance carriers to Medicare and Medicaid, there are important choices to be made in order to ensure a steady stream of patients in your office.

Basically, the decision on enrolling in Medicare or Medicaid comes down to your patient demographics. The type of patient that you want to attract to your office is based on the services you provide:

  • If you provide medical services to young families or the disabled in low-income areas, you would enroll in Medicaid to be reimbursed through that plan. Medicaid is a health insurance plan that covers low-income and needy people.
  • Health care providers that treat the elderly, for example podiatrists, geriatric specialists and physical therapists, would want to enroll in Medicare. Medicare covers those who are age 65 and over as well as certain people with disabilities.

But if your practice serves people of all ages and all socio-economic groups, you may want to enroll in both Medicaid and Medicare.

Important note: You are not required to participate in either Medicare or Medicaid. The choice is yours based on the type of patients that you treat.

Medicare Advantage Plans and Medicaid Managed Care Programs Are Credentialed Separately

If you decide to enroll in Medicare, you may consider enrolling in a Medicare Advantage Plan. These plans (Medicare Part C) are like an HMO or PPO and are offered by private companies. You must enroll separately in any Medicare Advantage Plan to be in-network. 

Similarly, if you enroll in Medicaid, you can also enroll in Medicaid Managed Care programs. These plans provide for the delivery of Medicaid health benefits and other services through contracted arrangements between state Medicaid agencies and managed care organizations. You must contract with them individually in order to be considered in-network.

However, it’s important to note that in order to be in-network with Medicare Advantage plans or Medicaid Managed Care plans, you have to be fully credentialed with traditional Medicare and Medicaid first.

Let Us Manage All Your Payer Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.