Private Option: What to do when patient has carrier card and Medicaid number

Under the “private option” coverage expansion, individuals that have been approved for coverage will first receive a letter which includes a Medicaid number.  The letter also provides directions to determine if they qualify for the Private Option. If they qualify for Private Option, they will be directed to select a plan from one of the carriers participating in the Marketplace and will be issued coverage with that carrier. Those individuals determined to be “medically frail” will be covered through traditional Medicaid (and have a Medicaid number only).

Some patients have been advised that if they require treatment prior to receipt of their insurance card, they should present their Medicaid number to the provider, but once they have been issued coverage by a carrier, they should present that carrier card to the provider. In most cases when you treat a patient that provides you with both an insurance carrier card and a Medicaid number, you should check eligibility and submit the claim to the insurance carrier.

There have also been questions as to whether the plans provided by the private carrier will be governed by Medicaid Rules and Regulations. Once a private carrier has been selected, the benefits, rules and regulations will be those of the issuing carrier. The coverage provided under these Qualified Health Plans will include the essential health benefits mandated by the health care reform law in order to be offered on the Marketplace, however, all other carrier rules and regulations will apply.

AMS Needs to Hear from You – With the roll-out of any new plan, it is expected that there will be bumps in the road with unintended consequences. The Society can help ensure that these issues get addressed ONLY if AMS knows about them. If your practice encounters problems with the carriers, patients, or rules of the new Affordable Care Act plans, please send a description of those problems to