Medicaid and Medicare are both important programs that provide access to health care for people in different circumstances. Unlike private insurance, these two programs are subsidized by federal and state government funds to allow recipients the ability to receive health care within certain guidelines.

Medicare benefits are usually available only to individuals who have reached a certain age or who have some type of qualifying disability. In the case of Medicaid, recipients must meet specific income criteria in order to have medical expenses covered, but there are also usually qualifications for benefits in terms of the amount of treatment needed.

Does Medicaid Have a Deductible?

A deductible is a dollar amount that must be reached prior to an insurance program activating its benefits. In the case of private insurance, a deductible amount will need to be paid by the insured prior to benefits of the plan becoming active. In the case of Medicaid, however, the deductible is the amount of medical debt incurred, and prior to reaching this amount of debt, an enrolled Medicaid recipient does not receive coverage for expenses, even if those expenses would normally be covered under Medicaid.

For example, someone who qualifies for Medicaid based on income can be enrolled in the program, but if the Medicaid program in that person’s state requires that at least $1,000 of medical expenses are acquired before coverage begins, the enrolled individual will not initially receive coverage for a $50 doctor’s visit. In a nutshell, traditional insurance coverage requires insured individuals to pay the deductible before receiving benefits, but Medicaid requires recipients to incur debt equal to the deductible before benefits begin.

It’s important to keep in mind that Medicaid is largely administered at the state level, so the amount of debt incurred to meet the deductible limit varies. Likewise, not all medical providers accept Medicaid, and the program doesn’t cover every possible medical treatment. Elective surgery, for example, may not be covered or included in the deductible amount. Once the deductible level has been reached, in most cases, Medicaid will cover all qualified expenses as long as treatment is provided by a Medicaid-approved medical professional or facility.

Does Medicare Have a Deductible?

Medicare benefits plans differ from Medicaid coverage in that Medicare recipients are required to provide payment for the deductible before benefits kick in. Although Medicare plans are different and the program has various parts that cover different medical treatments and needs, the deductible amounts are based on income and marital status and are set by the Medicare program. The deductible amounts can also change from year to year, so it’s important for seniors and qualified Medicare recipients to review their plan details at least once per year to ensure clarity as to patient responsibility of deductible cost.

Do Medicare Advantage Plans Have a Deductible?

Medicare Advantage plans will also usually have some type of deductible. The amount of the deductible can vary based on the plan’s provider and benefits chosen, but as with Original Medicare, the costs are based on the maximum covered by the Medicare program, so medical providers must still charge fees within guidelines set forth by the Medicare program.

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