When is Medicaid considered the primary insurance?

Medicaid is considered the primary insurance when it is the only insurance coverage the patient has. In this scenario, Medicare and other private insurances are not in play, meaning all the medical expenses of the patient will be covered under Medicaid. This is significant because primary insurance is responsible for covering the cost of healthcare services before any other insurance comes into play, ensuring that the patient's medical expenses are managed effectively within the Medicaid framework.

A patient whose only insurance is Medicaid will have all claims submitted to Medicaid, which will be responsible for determining payment benefits and making payments to providers as required by the program's guidelines. In other scenarios, such as having both Medicaid and a private policy, Medicaid typically acts as a secondary payer, which alters how claims are processed and how out-of-pocket costs may be managed.