Medicaid pays after Medicare plan; may pay nothing

My 86-year-old dad has Medicaid and a Medicare Advantage plan.  I would like to know why he is being billed from the hospital after a visit to emergency. It appears that the Medicare plan picked up the bill with the exception of $150. Does Medicaid pay for anything?

Dutiful Daughter

Dear Dutiful Daughter,

There is one reason that Medicaid may not have paid the $150: the Medicare Advantage plan already paid the hospital more than Medicaid’s fee schedule.  So, while Medicaid should pay second (after Medicare, in your father’s case), Medicaid may owe nothing on the bill.   Say the total bill was $1,000 and Medicare paid $850.  Medicaid’s payment for the ER visit would have been $500, and the hospital has already been paid more than that.  Therefore, Medicaid pays nothing.

Because your father has Medicaid, the hospital is not allowed to bill him for the difference.  It sounds like the hospital did not have his Medicaid ID.  Contact them and confirm that they have his Medicaid information, and that they have billed Medicaid.  This should straighten out the $150 bill.  If not, you should contact Medicaid’s member services for their help in getting the bill waived.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.