As the population ages and more people become eligible for Medicare, many Americans are supplementing their Medicare coverage with private health insurance or employer-sponsored coverage. In addition, there are some individuals who are eligible for both Medicaid and Medicare who have Commercial health insurance coverage as well.
Given the percentage of Medicaid beneficiaries who have one or more additional sources of health care coverage, we’re reminding providers that under current law, Medicaid is generally the payer of last resort for health care services. This means that if a Medicaid enrollee has multiple sources of health care coverage, Medicaid pays only after the other sources — such as private insurance or Medicare — are exhausted.
Point32Health’s Coordination of Benefits Quick Reference Guide can help you identify which plan is primary before submitting claims on behalf of patients with more than one health insurance plan. We encourage you to review the guide, which includes common coordination of benefit scenarios along with rules for members with Medicare plans and members with multiple Commercial plans.
You can also learn more by referring to the Coordination of Benefits section of our Provider Manuals.