What is considered the payer of last resort in medical insurance?

Medicaid is considered the payer of last resort in medical insurance. This designation means that when an individual has multiple sources of coverage, Medicaid will only cover medical expenses that are not paid by other insurers. This policy is in place to minimize costs to Medicaid and to ensure that federal and state resources are preserved for those who truly need them.

For example, if an individual is eligible for both Medicaid and another insurance plan, services will first be billed to the other insurance provider. Only after those claims have been processed and any payment (or denial) has been made will Medicaid step in to cover any remaining costs, ensuring that their funding is used efficiently and effectively.

The other options, such as Medicare, private insurance, and worker's compensation, do not hold the same designation. Medicare serves senior citizens and certain disabled individuals, while private insurance is based on individual or employer plans. Worker’s compensation is specifically for work-related injuries and illnesses. Each of these pays first when applicable, establishing Medicaid's unique role as the last payer in sequence.