What is Balance Billing?

Balance billing occurs when doctors, hospitals, or other providers charge beneficiaries with both Medicaid and Medicare for co-pays, co-insurance, or deductibles.

Patients who have both Medicaid and Medicare (including Medicare Advantage) should never be charged for services covered under Medicaid or Medicare. Balance billing is illegal under both federal and state law.

As more and more dual eligible patients move to managed care plans, balance billing may increase due to doctor & hospital confusion. Justice in Aging wants to make sure patients are protected. In 2011 we authored a policy paper on the need to improve protections for dual eligibles, Improving the Qualified Medicare Benefit for Dual Eligibles. Since then, we’ve been working to provide advocates with resources to help their clients who are being balance billed. See resources in tabbed sections below.