My 5-year-old son lives in Texas with his mother, while I live in Minnesota. My job offers several insurance plans, but to get him in-network care in Texas, I have to pay hundreds of dollars each month. He has Medicaid in Texas as secondary coverage. The issue is that Medicaid won’t pay until my insurance pays, and my insurance only kicks in after we’ve met a high deductible, leading to big out-of-pocket costs.
If I drop him from my employer’s plan, would Medicaid become his primary coverage and still provide full benefits? This would save me and his mother thousands of dollars each year.
If your son is seeing providers enrolled with TX Medicaid, Medicaid should cover costs as secondary insurance, even when the primary insurance applies the balance to your deductible. You shouldn’t have to pay anything out of pocket for a child with Medicaid.
We thought the same, but because of Third Party Liability, Medicaid won’t step in until my insurance pays, which only happens after deductibles are met.
Medicaid should pay after the claim is processed, which is different from waiting for the deductible to be met. The primary insurance tells Medicaid it didn’t pay, and then Medicaid pays its part.
The medical providers should bill your insurance first, and then bill Medicaid for what’s left after your insurance says what’s not covered. You shouldn’t have out-of-pocket costs since Medicaid covers what insurance doesn’t. It’s odd for your insurance to say they won’t pay their share unless you pay the part they don’t cover first.
I live and work in Texas, and my job offers BCBS of NC as health insurance. I have both my son and myself on the plan, and my son also has Medicaid. It’s a bit of a process, but when BCBS doesn’t pay because I haven’t met my deductible, Medicaid steps in. The amount Medicaid pays ends up counting toward my BCBS deductible.