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"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

Abstract: Most dual-eligible beneficiaries—people enrolled in both Medicare and Medicaid—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 Medicaid’s payment rate for the service exceeds Medicare’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)
Date: 2023-01-06
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