Medicare-Medicaid General Information
3/10/14 - Medicare-Medicaid Enrollee Categories Document posted.
The following questions have been the most frequently received from the general public into the Medicare-Medicaid Coordination Office e-mail box. By publishing this information on our website, we hope to provide Medicare and Medicaid beneficiaries and providers with the answers to their questions quickly and easily.
Q1. I have Medicare and Medicaid, both of which pay for most of my health care. But my doctor is telling me I still owe money. Is this right?
A1. If you have both Medicare and Medicaid, and the service you received is covered under Medicare, your doctor's office cannot bill you for any Medicare co-pay costs. If you have Medicare Parts A and B (also known as Original Medicare) or are in a Medicare health plan, AND Medicaid helps you pay for Medicare premium deductibles, and coinsurance, you are probably a Qualified Medicare Beneficiary (QMB).
NOTE: Your doctor may bill you for Medicaid co-pays. Please check with your local Medicaid office to find out more about your Medicaid status, including Medicaid co-pays. If you are still being told to pay a Medicare co-pay and the service is covered by Medicare, please contact 1-800-MEDICARE to file an anonymous complaint.
Q2. We are a doctor's office and heard that we cannot bill people with both Medicare and Medicaid, even if we do not participate in Medicaid. Is this true?
A2. For services that are covered under Medicare, you cannot bill a Qualified Medicare Beneficiary (QMB), even if your office does not accept Medicaid. A QMB is someone whose income does not exceed 100% of the Federal Poverty Limit and who is eligible for Medicaid paying Medicare premiums, deductibles, and coinsurance for both Part A and B.
Even if the person signs a document accepting liability for any treatment costs, you still cannot bill them, as QMBs cannot waive this right under Medicare. Providers who bill a QMB for costs above the Medicare and Medicaid payments (even when Medicaid pays nothing) are subject to sanctions.
For more information, please read the materials from CMS on balance billing practices: Medicare Learning Network Matters Article and Center for Medicaid and CHIP Services Informational Bulletin.
You can also receive more details about how Medicaid covers people with Medicare, or learn more about how people can get help paying their Medicare costs.
Apply for Medicaid
Q3. I need help in applying for Medicaid. I am not sure if I qualify and would like to find out more information.
A3.Please contact your State Medicaid Office to find out how to apply for Medicaid.
NOTE: Medicaid programs vary by state.
Moving? Take Your Benefits with You
Q4. I am moving next month to a different state and wanted to know if I could transfer my Medicaid benefits. What do I need to do to find out more?
A4. Medicaid programs are different in every state. If you're moving, contact the state you plan to live in to find out your benefit options.
Disability Competent Care Assessment Tool
Meeting the needs of persons with disabilities is of increasing importance as individuals live longer and the prevalence of adults with functional limitations and disabilities rises. The Disability Competent Care Assessment Tool was designed to help plans and health systems understand the disability-component care model and assess their organization's readiness to adopt it. An optional resource, the Tool seeks to enhance provider capacity to integrate care for adults with disability.
Other Programs That Can Help
State Health Insurance Assistance Programs (SHIP): This program may help you with general questions related to Medicare.
Supplemental Nutritional Assistance Program (SNAP): This program from the US Department of Agriculture can help put healthy food on your table.
- Page last Modified: 07/23/2014 2:40 PM
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