2015 Medicare Deductible, Coinsurance and Medicaid Blood Deductible Rates for Dual-Eligible (Medicaid and Medicare) Members

The South Carolina Department of Health and Human Services (SCDHHS) has updated its reimbursement calculations for Medicare Deductible, Coinsurance and Blood Deductibles to reflect the new 2015 Medicare Rates for Dual-Eligible (Medicaid and Medicare) members.

SCDHHS' payment for dual-eligible (Medicaid and Medicare) members is equal to the allowed amount minus the Medicare payment or the sum of the Coinsurance, Deductible and Blood Deductible (up to three units), whichever is less. The Centers for Medicare and Medicaid Services (CMS) has published new amounts for patients' Deductible and Coinsurance. Effective with dates of service on or after Jan. 1, 2015, the new rates are as follows:

  • Inpatient Deductible: $1,260.00
  • Outpatient Deductible: $ 147.00
  • Medicaid Blood Deductible: $100.00 per unit (not to exceed three units)
  • Inpatient Coinsurance: $9,450.00 (per period of illness 61-90 days)
  • Outpatient Coinsurance: 20% of Medicare's allowed charges

If you have any questions regarding this bulletin, please contact the Provider Service Center at 1-(888) 289-0709. Thank you for your continued support and participation in the South Carolina Medicaid program.

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