Can you clarify if
Medicaid only covers Medicare part B premium? Is the patient responsible for
the 20% coinsurance?
If you are referring to persons who only have coverage as Special Low Income
Medicare Beneficiaries (SLMB) or as Qualifying Individuals I (QI1), this would
be correct, but note that it is possible for a person to be eligible for both
SLMB and a full Medicaid coverage program at the same time. Crossover claims
policy would apply for those persons. More information can be found in the
Florida Medicaid Provider General Handbook
Patients that are enrolled in a Medicare Advantage Plan still think that
they have Medicaid second. What can we do to help us and them?
Florida Medicaid covers the Medicare Part C deductible and coinsurance up to
the Medicaid fee, less any amounts paid by Medicare. If this amount is
negative, no Medicaid payment is made. If this amount is positive, Medicaid
pays the coinsurance and deductible up to the billed or allowed amount,
whichever is less. The Florida Medicaid system is in the process of being
programmed to comply with the state’s policy governing Medicare Advantage plan
copayments. The system changes will be retroactive to January 1, 2010
Slide 38 of the presentation states that full Medicaid over-rules lower
programs. Then, on slide 61 it states that as the recipient is QMB along with
full Medicaid, the provider can bill for level of care (Medicare coinsurance).
Could you please clarify this issue?
The QMB coverage means that the person has Medicare (another payer) in addition
to the Medicaid coverage. The “level of care” refers to Nursing Facilities.
Even though this person does not have the Long Term Care Medicaid, they have
Medicare that could pay for Nursing Facility days (up to a limit). In this case
the facility can bill Medicaid for part A coinsurance only – level of care =X.
Of course, during the process of verifying eligibility, you would have already
seen the Medicare coverage information.
SLMB: What is the definition of a Medicare Premium?
The Medicare premium is the amount that a person with Medicare Part A and/or
Medicare Part B pays to Medicare to receive coverage.
