23 Miss. Code. R. 200-3.4 - Eligibility for Medicare and Medicaid
Medicare is the primary payor for a beneficiary who is both Medicare and Medicaid eligible and has four (4) parts:
A. Medicare Part A
1. The Division of Medicaid pays for the
Medicare Part A premium through a "buy-in" process for individuals who have
income that does not exceed 100% of the poverty level and are classified as
Qualified Medicare Beneficiaries (QMB) and QMB-dual recipients, meaning the
recipient is dually eligible as both a QMB and has full Medicaid through other
coverage.
2. The Centers for
Medicare and Medicaid Services (CMS) and the Division of Medicaid work jointly
to ensure that all eligible individuals are included in the "buy-in" process
for Medicare coverage. Persons who may be Medicaid-eligible should apply at the
appropriate certifying agency.
B. Medicare Part B
1. The Division of Medicaid pays the Medicare
Part B premium through a "buy-in" agreement with the Social Security
Administration (SSA) for all Medicaid eligible individuals who also qualify for
Medicare Part B. CMS and the Division of Medicaid work jointly to ensure that
all eligible individuals are included in the "buy-in" process.
2. The Division of Medicaid also pays Part B
premiums for specified low-income Medicare beneficiaries (SLMBs) and certain
qualifying individuals (QIs). SLMBs and QIs do not receive a Medicaid ID card
or any other benefits.
C. Medicare Part C (Medicare Advantage Plans)
1. The Division of Medicaid pays for the
Medicare Part C coinsurance and deductible for beneficiaries in applicable
Categories of Eligibility (COE).
2.
For purposes of reimbursement, co-payments charged by a Medicare Part C plan
are considered to be coinsurance.
D. Medicare Part D (Medicare Prescription
Drug Plan)
1. When Medicaid beneficiaries
have both Medicare and Medicaid coverage, pharmacy providers are required to
bill Medicare for drugs covered by that program.
2. The Division of Medicaid considers the
Medicare payment as payment in full for Medicare Part D pharmacy claims.
Notes
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