Dual eligible relative specialist visit question

[medicaidaccesstalk761]

I'm trying to assist my aunt with her healthcare, and I've come across something a bit tricky. She's got both Medicare and Medicaid, but the specialist she was referred to only takes Medicare.

If she decides to go ahead with the appointment, will Medicaid cover the 20% coinsurance, or could she end up with an unexpected bill? I just want to make sure she isn't caught off guard.

 

[hlthcr276]

Your aunt is considered dual eligible.
Medicare should pay first then Medicaid should cover the remaining out-of-pocket costs, including the 20% coinsurance, but only as long as the service is also covered by Medicaid.
But if the specialist is only taking Medicare, it could mean that he's not enrolled with Medicaid, then Medicaid won't pay anything..
To avoid a surprise bill, I suggest you call the specialist's billing office and confirm if he's a participating Medicaid provider in your state.
Also confirm your aunt's specific Medicaid benefit level!!