AHIP Practice Exam

If Mr. Cole is a Medicaid beneficiary who became eligible for Medicare, what should he know about cost-sharing?

1. Medicaid will pay for all his Medicare services.

2. No changes in cost-sharing apply to him.

3. Medicaid covers cost sharing only for participating providers.

4. Medicare will handle all his cost-sharing expenses.

The correct answer is: Medicaid covers cost sharing only for participating providers.

Mr. Cole, as a Medicaid beneficiary who has also become eligible for Medicare, should be aware that Medicaid plays a crucial role in covering his cost-sharing responsibilities. Option C highlights a key aspect: Medicaid covers cost-sharing only for participating providers. This means that if Mr. Cole receives services from healthcare providers that accept Medicaid, his costs (such as deductibles, coinsurance, and copayments) may be fully covered by Medicaid. This is essential for ensuring that he does not face out-of-pocket expenses for essential care. Understanding that coverage is tied to provider participation is important because if Mr. Cole uses a provider who does not accept Medicaid, he may not receive the same cost-sharing assistance, leading to potentially higher out-of-pocket costs. Consequently, it is vital for him to seek services from providers who are aligned with both Medicare and Medicaid. This option clarifies the nature of Medicaid's role in health care financing for those who are dual-eligible. Each of the other options does not accurately reflect the nuances of Medicaid's cost-sharing provisions for Medicare services.