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Wiki Medicare QMB patients with Advantage plans

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wendelldebbie

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Elizabethtown, North Carolina
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I understand that a patient having Medicare and Medicaid QMB as secondary is not to be billed for deductible or co-insurance. Is this the case if these same patient's change to a Medicare Advantage Plan?
 
Yes, it's still the case. Usually when a QMB enrolls in a MA plan, they are enrolled at the same time in that payer's managed Medicaid plan, which will pay any cost-shares that are due after the MA plan pays, so there shouldn't be any balances once both plans have processed the claims.
 
wendelldebbie said:
So the Medicaid plan will be seperate then, correct?
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Yes, in my experience that is the case. So, for example, a patient may have a UnitedHealthcare Medicare Advantage plan, and if there's any balance due, the same claim will be processed and paid (or shown to be paid in full and no further balance due) by the United Medicaid plan. But you may still have to bill the Medicaid plan if it doesn't automatically cross over. Either way, you can't bill the patient if they are eligible for Medicaid unless the Medicaid plan itself shows that there is a patient responsibility.
 
What if we do not accept Medicaid but we accept the Medicare advantage plan? Can we bill the patient?
 
We have a local Advantage plan specifically for people with Medicare and Medicaid. I spoke at length with our HMO, and they said that this Advantage plan takes the place of BOTH the Medicare and Medicaid, and the $10 copay that they have for specialists is to be collected from the patient. YMMV.
 
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