Reminder: Qualified Medicare beneficiaries can’t be balance-billed for Medicare services

Keep in mind that qualified Medicare beneficiaries do not pay coinsurance or copayments for Medicare-covered services received from Medicare or Medicaid participating providers.

The state Medicaid program may pay for all or part of these cost-sharing amounts. All Medicare or Medicaid payments are considered full payments to providers.

Qualified Medicare beneficiaries are entitled to Medicare Part A and eligible for Medicare Part B. They have incomes below 100 percent of the federal poverty level and must be deemed eligible by their state Medicaid agency.

According to the August 2012 issue of MLN Matters, all Medicare physicians and suppliers who offer services or supplies to qualified Medicare beneficiaries cannot balance-bill those beneficiaries. This is explained in Section 1902 (n)(3)(B) of the Social Security Act as modified by Section 4712 of the Balanced Budget Act of 1997. Providers or suppliers who bill beneficiaries for Medicare cost-sharing are subject to sanctions.