If you have other insurance that pays before Medicare:
- Your other insurance may require you to use a supplier that isn't a contract supplier.
- In this situation, Medicare may make a secondary payment to that supplier. The supplier must meet Medicare enrollment standards and be eligible to get secondary payments.
For more information, check with your benefits administrator, insurance company, or your plan provider.
I have Medicare and Medicaid. Will Medicaid cover an item I get from a non-contract supplier if Medicare doesn’t cover it?
If you have Medicare and Medicaid and live in a Competitive Bidding Area, you'll get off-the-shelf back and knee braces and related supplies and accessories from a Medicare contract supplier. Medicaid may pay the cost-sharing amounts (deductibles, coinsurance, and copayments) for those services.
- If you’re a Qualified Medicare Beneficiary (QMB) only, Medicaid pays Medicare deductibles, coinsurance, and copayment amounts only. If Medicare denies payment, Medicaid won’t pay for the item.
- If you’re a QMB Plus, Specified Low-Income Medicare Beneficiary (SLMB) Plus, or you have Medicare and full Medicaid coverage, Medicaid will pay Medicare cost-sharing amounts for Medicare-covered supplies and equipment. If Medicare doesn’t cover the supplies and equipment, but the Medicaid state plan does, you'll still be able to get supplies and equipment that Medicare doesn’t cover (but your state Medicaid program does cover) from any Medicaid-participating provider subject to limitations established in the state plan.
- If you’re a QMB Only or QMB Plus, suppliers can’t bill you for any Medicare cost sharing (other than nominal copayments under Medicaid, if applicable), even if the state Medicaid program’s total payment is less than the total amount of the Medicare cost sharing.
Contact your Medicaid office for more information.