"Lesser-of" Payment Policies and the Use of Physicians' Services Among Dual-Eligible Beneficiaries: Working Paper 2023-01
Tamara B. Hayford,
Xiaotong Niu and
Sandra L. Decker
No 57843, Working Papers from Congressional Budget Office
Most dual-eligible beneficiariesâ€”people enrolled in both Medicare and Medicaidâ€”are eligible for Medicaid through their enrollment in the Qualified Medicare Beneficiary (QMB) program, which requires that states pay for Medicare cost sharing. Since 1997, states have gradually implemented policies under which they pay the lesser of Medicare cost sharing and the amount, if any, by which Medicaidâ€™s payment rate for the service exceeds Medicareâ€™s payment rate. Consequently, physicians in most states receive roughly 80 percent of the Medicare rate for primary care services
JEL-codes: I13 I18 (search for similar items in EconPapers)
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Persistent link: https://EconPapers.repec.org/RePEc:cbo:wpaper:57843
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