Medicare and Medicaid

How do you bill secondary Medicaid when Medicare is with an HMO?


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2011-03-17 19:26:43
2011-03-17 19:26:43

You submit an EOB from the Medicare HMO with your Medicaid claim.

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You cannot bill Medicaid for your HMO deductibles. However, if you are medicaid eligible, you don't need a Medicare HMO - Medicaid should be paying your Medicare co-payments, deductibles, and any other covered expenses that Medicare doesn't pay. If you are on Medicaid spend-down, your HMO deductible is a medical expense that can be applied to spend-down.

Certainly altho I see no benefit for a Medicaid recipient. The HMO would be the primary insurer and Medicare secondary. Medicaid is always the payor of last resort. However, there shouldn't be any expenses for Medicare or Medicaid to pay.

If they are under skilled HMO yes you can bill Medicare. You still have to follow the assessments needed by Medicare

yes some plan, medicare work with hmo .

There are a variety of Medicare HMO plans that are available for all kinds of incomes. Under the new Obama health plan, everyone should be available to get a medicare HMO plan.

That will depend on your location. A comprehensive list can be found at

No, Medicare is a Fee For Service Program, but doctors must contract with Medicare to treat Medicare patients

Hospitals are reimbursed by Medicare for handling a high level of indigent patients and are also reimbursed for educating interns and residents. When a Medicare patient is covered by a Medicare Replacement Plan (HMO Insurance for medicare patients), the hospital can only get the extra reimbursement for indigent patients and educating intern and residents if they send Medicare a "shadow bill". Basically, it is a copy of the identical bill sent to the HMO which is submitted to Medicare only for the purpose for the extra payment.

I' don't know how it works on your Sate, but in FL, all you have to do is call Medicaid office ( number on back of the card) between the 1st and the 15th of the month ( any month) and tell them that you no longer want to be in HMO, and they will take care of the rest, and you will be eligible for straight medicaid the 1st day of the following month the same with medicare.

The most popular medicare HMO plan I know of is Humana. You can check out their website at They are a great HMO. So great in fact my own family uses them.

The answer depends on what type of Aetna Medicare Plan you have. If you have an Aetna Medicare Supplemental Plan, then Original Medicare pays first and the Aetna plan pays secondary If you have an Aetna Medicare Advantage HMO Plan, then the Aetna plan will always be primary as Medicare has assigned the benefits over to Aetna for processing and administration.

There is a comapny MDMedicare complete that offers an HMO which gives you back 60.00 of the premium for your Medicare You are paying Medicare approx $94.00this plan gives you back $60.00 so you only pay $34.00 approx Bill

The most popular Medicare HMO is Secure Horizons. It offers a primary care physician that provides referrals to specialists and the insured is only responsible for a copay.

They could need a Medicare HMO plan if they are over a certain age, and meet a certain income requirement. If they don't already have health insurance, this is something to look into.

medicare does not covere preventative. you need a HMO/PPO policy or a supplement

Visit to compare Medicare HMO's in your area. You can then select one and enroll on the website.

You can go to There are also several other websited dedicated to helping with medical hmo information services.

Yes, if you are contracted with the secondary payor, PPO contract, HMO contract, etc, you are bound by your contract to bill the plan

Secure Horizons offers medical insurance for Medicare. You can chose from Medicare Advantage which is similar to an HMO or Medicare Supplemental which will cover what your primary insurance will not.

Yes. All you have to do is send in a cancellation letter or send it to your insurance agent and have them send to the HMO company. Once they receive it, they will then have medicare reinstated as your primary health care. Maybe get in contact with your agent and see about a medicare supplement policy. They will cover any gaps that medicare doesn't pay providing you can answer all their health questions yes.

In most cases they will not need Prescription Drug Coverage as it is covered under the HMO. If you have any questions contact an insurance professional.

The HMO is the least expensive and most restrictive Medicare managed care plan.

Medicare Advantage Plans are health plan options (like an HMO or PPO) approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called "Part C" or "MA Plans." Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. Medicare Advantage Plans provide your Medicare health coverage and usually Medicare drug coverage. They aren't supplemental insurance. For more information, see the Medicare and You 2009 book here:

Medicare does not cover hearing aids unless certain specific criteria are met. With a Medicare HMO plan, you can be covered after you purchase the hearing aids (assuming you meet the coverage criteria).

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