Mrs. Walters is enrolled in her state’s Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage plan?

High school
1

Mrs. Walters is enrolled in her state’s Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage plan?

a. If a provider accepts her Medicare HealthPlan coverage, that provider is legally obligated to also accept her Medicaid coverage, so she does not need to worry about finding providers who participate in both Medicare and Medicaid.
b. Medicaid will coordinate benefits only with Medicaid participating providers.
c. She can submit any bills she has for co-payments under Medicare to the state’s Medicaid program and they will always be fully covered.
d. State Medicaid programs do not coordinate any of their coverage with Medicare Health Plans.

2

LectureNotes said Mrs. Walters is enrolled in her state’s Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage plan?

Answer: When Mrs. Walters, who is enrolled in her state’s Medicaid program in addition to Medicare, is considering enrollment in a Medicare Advantage plan, there are several important aspects she needs to be aware of. Here’s a detailed breakdown of each option provided:

a. If a provider accepts her Medicare HealthPlan coverage, that provider is legally obligated to also accept her Medicaid coverage, so she does not need to worry about finding providers who participate in both Medicare and Medicaid.

  • This statement is incorrect. There is no legal obligation for providers who accept Medicare Advantage (Medicare HealthPlan) coverage to also accept Medicaid. Mrs. Walters would need to ensure that her healthcare providers participate in both Medicare and Medicaid programs, especially since not all providers accept both types of insurance.

b. Medicaid will coordinate benefits only with Medicaid participating providers.

  • Correct. State Medicaid programs coordinate their benefits with providers who participate in Medicaid. This means that for Mrs. Walters to fully utilize her Medicaid benefits, she must ensure that the providers she chooses for her healthcare services participate in Medicaid.

c. She can submit any bills she has for co-payments under Medicare to the state’s Medicaid program and they will always be fully covered.

  • This statement is misleading. While it is true that Medicaid can help with co-payments, deductibles, and other out-of-pocket expenses for dual-eligible individuals (those eligible for both Medicare and Medicaid), the extent of the coverage can vary. There may be instances where not all costs are fully covered, depending on the specific rules of the state’s Medicaid program.

d. State Medicaid programs do not coordinate any of their coverage with Medicare Health Plans.

  • This statement is also incorrect. State Medicaid programs do coordinate with Medicare Advantage plans to some extent, especially for dual-eligible individuals. Coordination includes covering costs like copayments, deductibles, and services that Medicare does not cover, depending on state Medicaid policies.

Final Answer:
When considering the correct statement in the context given, option b is the most accurate: “Medicaid will coordinate benefits only with Medicaid participating providers.”