Medicaid is a program managed and funded jointly by the states and federal government to provide health insurance for individuals and families with low income. Finding the right health insurance can be critical to the long term health and well being of your family. While you may qualify for Medicaid, you may also need commercial health insurance. Here is a quick comparison of each health insurance.
Comparison of Commercial Insurance and Medicaid
Commercial insurance
Medicaid
Preexisting condition exclusions
Permitted within HIPAA limitations
Prohibited
Categories of covered benefits
Limited to "major medical" care with certain preventive benefit additions to limit risk exposure
All service classes within federal medical assistance definition are mandatory for children. Broad coverage includes care related to special health care needs.
Benefit definitions
Insurer's discretion
Defined by federal law
Limitations and exclusions
Typically included
No limits where care is medically necessary and service falls under definition of medical assistance
Patient cost-sharing
Left to the discretion of the insurer and purchaser
Prohibited for children under age 18
Medical necessity
Left to the discretion of the insurer
Preventive pediatric standard
Source: S. Rosenbaum, A. Markus, C. Sonosky et al., Policy Brief #2: State Benefit Design Choices Under SCHIP-Implications for Pediatric Health Care (Washington, D.C.: George Washington University, 2001).