Medicare/Medicaid SLMB patient responsibility

[dawnadoss]

When Medicare is primary and ded/coins apply, and a Medicaid secondary SLMB patient's claim denies 858, can we bill the member? If so, what requirements are there for billing the member? Is an ABN necessary?

 

[sls314]

When Medicare is primary and ded/coins apply, and a Medicaid secondary SLMB patient's claim denies 858, can we bill the member? If so, what requirements are there for billing the member? Is an ABN necessary?

SLMB isn't true Medicaid coverage. It's a savings program that only pays for the Part B premiums. The patient is still responsible for deductibles and coinsurance.

QMB covers the Part B premiums and deductibles/coinsurances.

You can see a description of the different types of Medicare Savings Programs here:

https://www.medicare.gov/basics/costs/help/medicare-savings-programs