Coordination of Benefits (COB) refers to the activities involved in determining Medicaid benefits when an enrollee has coverage through an individual, entity, insurance, or program that is liable to pay for health care services. Individuals eligible for Medicaid assign their rights to third party payments to the State Medicaid Agency.

Examples of third parties which may be liable to pay for services:

• Group health plans

• Self-insured plans

• Managed care organizations

• Pharmacy benefit managers

• Medicare

• Court-ordered health coverage

Waivers and Demonstrations:

States can apply to CMS for waivers to provide Medicaid to populations beyond those traditionally covered under the state plan. Some states have additional state-only programs to provide medical assistance for certain low-income people who do not qualify for Medicaid. No federal funds are provided for state-only programs.

Premium: A monthly amount you pay for coverage, whether you get services or not.

Deductible: An amount you have to pay for covered services and items each year before Medicare or your plan starts to pay.

Coinsurance: A percentage of the cost that you pay. In Part B, you generally pay 20% of the cost for each Medicare-covered service.

Example

A Medicare-covered service costs $100. Medicare pays $80 and you pay $20. ($100 x 20% = $20.)

Copayment: A fixed amount you pay for a Medicare-covered service, like $30.

For More Related Topics or Detail on Medicaid, please visit the government's website: https://www.Medicaid.gov/Medicaid/eligibilty