What is the difference between medicaid and qualified health plan

 What is the difference between medicaid and qualified health plan

Aspect	Medicaid	Qualified Health Plans (QHPs)
Eligibility Criteria	Eligibility is based on income and other factors, and it is primarily available to low-income individuals and families, including those with disabilities and certain other categories.	Available to individuals and families across a wide range of income levels, with eligibility determined by factors such as income, household size, and citizenship status.
Income Limits	Has income limits set by federal and state governments, and eligibility varies by state. Medicaid often covers those with incomes below the federal poverty level (FPL) and extends to higher income thresholds in some states.	QHPs do not have strict income limits, making them accessible to a broader range of income levels, including those above the FPL. Premium subsidies are available to eligible individuals and families with incomes between 100% and 400% of the FPL.
Funding Source	Funded jointly by federal and state governments, with federal matching funds provided to states based on a formula.	Privately purchased through health insurance marketplaces (exchanges) established by the Affordable Care Act (ACA) and paid for by individuals, families, or employers.
Coverage Options	Offers comprehensive coverage, including essential health benefits, preventive services, and long-term care for eligible populations.	Offer a range of coverage options with varying levels of benefits and costs. Plans must include essential health benefits, but specific coverage details may vary.
Premiums	Premiums for Medicaid are typically very low or nonexistent for eligible individuals and families, with cost-sharing limited to nominal fees for certain services.	QHPs require payment of monthly premiums, which vary based on the selected plan, income level, and subsidy eligibility.
Cost-Sharing	Medicaid has minimal or no cost-sharing requirements for eligible individuals, with services often provided at no out-of-pocket cost.	QHPs may have cost-sharing requirements, including deductibles, copayments, and coinsurance, depending on the specific plan chosen.
Provider Networks	Medicaid has its own network of participating healthcare providers, including doctors, hospitals, and clinics, with varying levels of access and provider choice.	QHPs have provider networks established by insurance companies, offering a broader choice of providers but may involve considerations of in-network vs. out-of-network care.
Essential Health Benefits	Medicaid covers essential health benefits as defined by federal law, which include services such as hospital care, doctor visits, prescription drugs, preventive care, and mental health services.	QHPs are required to cover essential health benefits, but specific coverage may vary by plan, and insurers may offer different levels of coverage and additional benefits.
Enrollment Periods	Enrollment in Medicaid is available year-round for eligible individuals and families, with no specific annual open enrollment period.	Enrollment in QHPs typically occurs during the annual open enrollment period established by the health insurance marketplace, with some exceptions for qualifying life events.
Special Enrollment	Medicaid enrollment is available at any time for those who meet eligibility criteria, including circumstances like pregnancy or disability.	QHPs may allow special enrollment for individuals experiencing qualifying life events such as marriage, birth or adoption of a child, or loss of other coverage.
Subsidies	Medicaid provides coverage at little to no cost to eligible individuals, with no need for premium subsidies.	QHPs may offer premium subsidies and cost-sharing reductions to eligible individuals and families to make coverage more affordable.