Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered service. How much may the doctor collect from Mr. Rivera?
The doctor may only collect from Mr. Rivera the cost sharing allowable under the statés Medicaid program, which are according to federal requirements. The medicaid program is founded jointly by states and the federal goverment.
