A REMINDER FOR NY STATE PROVIDERS: Medicaid and Medicare Part B Coinsurance Reimbursement

Since July 1, 2015, Medicaid of NY no longer pays the full 20 % of the Part B coinsurance after Medicare pays its 80%. Medicaid may cover Part B coinsurance only in cases
when Medicare payment is less than the Medicaid fee. In any case, the total Medicare/ Medicaid payment will not exceed the amount that Medicaid would have paid for a Medicaid-only patient. If the Medicare payment is greater than the Medicaid fee, no additional payment will be made.

The above changes did not affect the following:
• Ambulance providers,
• Psychologists,
• Article 16 clinics,
• Article 31 clinics, and
• Article 32 clinics.

Medicaid continues to reimburse these providers the full Medicare Part B coinsurance. Note that the rule above only applies to coinsurance. 
Medicaid still covers in full Medicare Part B deductible.

The Medicare and Medicaid payment (if any) must be accepted as payment in full. Per State regulation 18 NYCRR Section 360- 7.7, a provider of a Medicare Part B benefit cannot seek to recover any Medicare Part B deductible or coinsurance amounts from Medicare/Medicaid Dually-Eligible Individuals.

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