Originally published January 17, 2019. Payer rules change; confirm current CMS and payer requirements before billing.
Medicare Part B coinsurance
Since July 1, 2015, New York Medicaid no longer pays partial Medicare Part B coinsurance. The combined Medicare and Medicaid payment to the provider will not exceed what the provider would have received for a Medicaid-only patient. If the Medicare payment is higher than the Medicaid fee, Medicaid pays nothing more.
More information: NY Medicaid Update, June 2015.
Medicare Part C copayments and coinsurance
Since April 1, 2016, Medicaid pays 85% of the Medicare Part C (Medicare Advantage) copayment or coinsurance amount.
More information: