Follow
Share

I have Medicare and Medicaid. I was told that Medicare would be my primary, Medicaid my secondary and that my MMA won't be billed. I would like to cointue using the docotrs as I have been doing, but my MMA provider told me that I have to use one of their network doctors as my primary care.

This question has been closed for answers. Ask a New Question.
Find Care & Housing
Clementina, you opted to join the MMA. No one can force you. Now you have changed your mind. Talk to your social worker. You can't have it both ways.
Helpful Answer (0)
Report

MMA has multiple meanings in Medicare. I assume you mean some kind of accountable care organization. If so, pamstegman is right that you should not be forced to stay within the network (you can be assigned to one but can opt out of the record sharing involved). Since you say Medicaid is involved, the rules probably vary by state
Helpful Answer (0)
Report

MMA= Managed Medical Assistance. For example, in Florida MMA is run by United Healthcare. Like Blue Cross or Univera or Independent Health, you stay within network providers, including nursing homes. It is an OPTION.
Helpful Answer (0)
Report

I forgot to state that I live in Florida and Medicaid overhauled the Medicaid system where we all had to pick a Managed Medical Assistance, or else they would pick one for us. So I didn't change my mind. I'm in a chosen network, and I was just wondering if I had to pick the network doctors or if I could just continue as I was doing. Thank you for trying to help me. I guess I'll follow my heart and continue as I was, and see what happens. I will tell you the results as I go along.
Helpful Answer (0)
Report

You should have been given a list of providers by your MMA. You should have a handbook with all this information including a prefered list of medications that they will cover.
If you go your own way you may find you are stuck with the bill because you are not following their rules. You can also ask your prefered Drs office if they participate in your MMA.
Helpful Answer (0)
Report

Clementina

OK. First, there is a big notice on the Florida MMA home page says: "Note: The SMMC program will not change your Medicare benefits." So one follow up question would be what Parts of Medicare are you on? And are you on a private supplement on top of or in addition to your Florida Medicaid MMA and one or more Parts of Medicare. (I would think not but that is possible so just asking...)

Second, the Florida Medicaid web page says "The plan you pick will be required to cover your services with your current providers for up to 60 days while you move to new providers in your new plan’s network (which you say you chose, correct?--Byron). You may want to pick the plan that has most of the doctors and services that are important to you." So,the Florida Medicaid MMA appears to be an HMO type of arrangement. and hopefully you took its advice and chose a plan with your doctors in it when you enrolled. But to literally answer one of your questions, the plan picks "the network doctors," not you. Then you choose doctors from the provider options the plan gives you.

But I am guessing that is not what you really want to know. Back to your original question, you use the word "primary" two different ways.

1. Your first use relates to an insurance term that denotes which "insurer" pays the provider first. Someone told you Medicare would be your "primary?" Why do you want to know how all the bureaucrats pass paper among each other? How Medicare would deal with this will depend on what Parts of Medicare you have. How Florida Medicaid deals with it seems to depend on what county you live in and what Florida Medicaid MMA plan you chose. You will not decide who pays first; the "insurers" (probably all the government in your case) will decide. It appears in general Medicare is primary in this sense of the word.
2. The second time you use the word "primary," you are referring to a primary care physician. Different meaning of "primary" than in meaning 1. If you have a Part of Medicare that lets you pick your doctors from among any doctor that accepts Medicare, you can probably still pick your doctors, including your primary care physician. But that might affect your Florida Medicaid benefits for health care services (e.g., dental, optical supplies, optometrist, transportation other than in an emergency) not provided by Medicare. It depends on what the Florida plan says. Folks on both Medicare and the VA handle this situation by sort of having two primary care physicians. I know; that sounds silly but this is the government... a person on VA sees the VA PCP once a year which then allows him or her to get VA to be the primary payer for his or her drugs. For everything else the person sees the PCP he or she really wants (or the one designated by his or her Part C plan) and the relevant Part of Medicare as the primary payer.

(Sidelight: MMA in this case does not have the most common Medicare meaning. Do not use that acronym if you are talking to someone at Medicare.)
Helpful Answer (0)
Report

Thanks for trying to help. When I go to a doctor and hand them my Medicare and Medicaid card, they ask me which one is my primary insurance. Yes, I have Medicare part A, B and D.
I got my question answered already.
Helpful Answer (0)
Report

This question has been closed for answers. Ask a New Question.
Ask a Question
Subscribe to
Our Newsletter