Medicaid vs. Provided Health Insurance

[mistoffolees]

>that's not what I read either.
>
>I read it like Sherry said.

Then please explain why he said that it would save him from paying copays. The only way that statement makes sense is if he thought she would use Medicaid instead of private insurance.

If he used Medicaid in addition to private insurance, then it would not have had any impact on his copay.

>
>And if Medicaid knows there is another policy, chances are
>they will deny the claim until the primary (other) insurance
>pays first.

If the find out about it. That's what I said.

[MixedBag]

Primary insurance pays all except $25 co-pay.

Medicaid picks up the co-pay.

So it really saves both parents from sharing the $25 expense.

Medicaid doesn't pick up the entire tab because the private insurance pays first according to their rules.

[mistoffolees]

>Primary insurance pays all except $25 co-pay.
>
>Medicaid picks up the co-pay.
>
>So it really saves both parents from sharing the $25 expense.
>
>Medicaid doesn't pick up the entire tab because the private
>insurance pays first according to their rules.

I guess that's one possible reading - but it would make the OP even more guilty since they would be directly accepting payment from Medicaid even if they're not eligible.

[MixedBag]

no, because payment goes directly to doctor, not to either parent.

And if the eligibility is based on the parent (see, I don't know this part), and that parent truly does qualify for medicaid....how is it wrong?

Because the other parent benefits who carries other insurance?

I know that when Tri-Care picks up the rest of the tab, they are happy that there was a Primary Insurance who paid the bulk of it.  

And I just had a conversation with EX#1 who told me that there's a law effective Jan 1st that says IF there is other insurance available through employment, the employee has to enroll if they are also eligible for Tri-Care.  Translation:  The law cuts the cost of Tri-Care payouts by tons and military (active duty and retired) now have an increased expense IF insurance is available to either the member or their spouse.

I didn't dig into it because it doesn't affect me.  

But it would make me wonder.....our son is covered under my Tri-Care (retired).  I am CP (now).  EX covers him under his BC/BS.  And I know Tri-Care will say BC/BS is still primary (federal law somewhere).  And I wonder how or what Tri-Care would say if EX were to drop the BC/BS coverage????  oh well, a whole nother thought and thread.

[mistoffolees]

If one parent does not qualify while the other parent does qualify, then it would be legitimate for Medicaid to pick up the copay for the parent who qualifies. It would be fraudulent for Medicaid to be asked to pay the copay for the parent who does not qualify - which is what was being suggested here.

[lucky]

I'm sorry, Mist, but I didn't read it that way.

I read it that the poster doesn't think it's right, and was questioning that but he noted that he kind of gets a "bonus" out of it because his ex qualifies and Medicaid will pick up the co-pay - therefore he legitimately doesn't have to pay his half because there IS NO co-pay to be paid now.  Medicaid pays it.

I don't think the poster meant to defraud anyone.  I think the poster was looking for info to [em]make sure[/em] neither he nor his ex was defrauding anyone by his ex using Medicaid.


[em]Lucky

Lead your life so you wouldn't be ashamed to sell the family parrot to the town gossip.
- Will Rogers[em]

[mistoffolees]

One could question what he meant, but the result is the same.

Note that he said that he and his ex split the deductible. Then he said if she uses Medicaid, he doesn't have to pay anything. He therefore benefits from the fraudulent use of Medicaid.

Whether he intends to defraud is irrelevant. He is clearly benefiting - since he is responsible for half of the deductible.

[lucky]

Mist,

What part of "if the ex is eligible there is no fraud" do you not understand?

The only way it IS fraud is if neither the ex nor he is eligible - it appears that the ex IS legally eligible therefore no fraud on ANYONE'S part.

When it comes to Medicaid, the fact that there is other insurance from the applicant's ex available for the children is irrelevant as it pertains to eligibility.  It's THAT simple.

I re-read his post and the only thing I see is that he wishes he didn't have to pay the premium, not that he won't, but that he doesn't like it.

I can't see how you can justifiably claim that this poster is commiting fraud.

[em]Lucky

Lead your life so you wouldn't be ashamed to sell the family parrot to the town gossip.
- Will Rogers[em]

[Mamacass]

I feel the same, that it is a moral issue.  We carry insurance on SS, and BM is on disability, so she has suggested to us several times that we can use his medicaid to save money.  I'm assuming she is talking about the copays.
I just can't feel good about using medicaid when we can afford health care.  To me that is taking advantage of a system that is there to help those who can't afford health care.  

[Sherry1]

Washington State Medicaid contacted my DH directly and asked him to mail them a copy of his insurance cards, which he did.  DH's insurance became primary then medicaid paid whatever his insurance didn't.  It's a pretty common practice.