Important Medicaid/Medicare information
The following document will explain what the Florida Medicaid guidelines are in reference to coverage of copayment, coinsurance and deductable when a client has Medicare as their primary insurance carrier. This document is a copy of chapter four, page 2 in the Florida Medicaid Provider General Handbook.
If you would like a printable PDF version of this page Click here!
| Medicare Coverage, continued | |
| Medicare Part A |
Medicare Part A insurance provides coverage for medically-necessary inpatient hospital care, specified skilled nursing care, specified services of a home health agency, and other services. Medicare imposes cost sharing expenses by requiring deductible and coinsurance amounts that may be paid by the Medicare beneficiary, a supplemental insurance policy, or Medicaid. |
| Medicare Part B |
Medicare Part B Insurance provides basic health care coverage for the services provided by doctors, suppliers, therapists, and other health care providers. Medicare imposes cost sharing expenses by requiring deductible and coinsurance amounts that may be paid by the Medicare beneficiary, a supplemental insurance policy, or Medicaid. Per 42 Code of Federal Regulations, Section 431.625 (d)(3), Medicaid cannot reimburse expenditures that could have been paid for under Medicare Part B, but were not, because the person was not enrolled in Part B. This limit applies to all recipients who are eligible for enrollment under Part B, whether individually or through an agreement under section 1843(a) of the Social Security Act. |
|
Medicare Part C (Medicare Advantage Plans) |
The Balanced Budget Act of 1997 permits Medicare beneficiaries to select either the traditional fee-for-service Medicare program or the Medicare Part C program, known as Medicare Advantage Plans or Medicare Replacement HMOs. The Medicare Part C program allows the beneficiary to choose among various private health care including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Provider Sponsored Organizations (PSOs), or Medical Savings Account (MSA). Persons who are eligible for Medicare Part A and who are enrolled in Medicare Part B are eligible for enrollment in the Medicare Part C program. Medicaid does not reimburse copayments, coinsurance, or deductibles for any service provided under any Medicare Part C plan. |
