Understanding How Medicare Works with Other Insurance Policies

Understanding How Medicare Works with Other Insurance Policies

Medicare is a form of health insurance. The policy is especially beneficial to people who may not qualify for another form of health insurance. While researching coverage, you need to know how Medicare works with other types of insurance.
If you have Medicare along with other health insurance coverage, each coverage will be called a “payer.” If there is more than one payer, the “coordination of benefits” rules will determine which one is to pay first. The primary payer covers your bills first and then sends the rest to the supplemental payer to pay. Depending on your unique circumstances, there may be a third payer.

  • Primary and Secondary Payer Explained

    The primary payer pays up to the limits of its coverage. The secondary payer only covers the leftover balance that the primary insurer didn’t cover. Keep in mind that the secondary payer may not cover all of the remaining balance. If you plan to use your employer’s insurance as the secondary payer, you may be required to enroll in Medicare Part B before your insurance takes over. If the insurance company doesn’t cover the claim within four months (120 days), your doctor may send an invoice to Medicare. While Medicare will make a conditional payment towards the bill, they will later recover any payments that the primary payer was responsible for.

  • Conditional Payments

    Conditional payments are payments made by Medicare for which another payer was initially responsible. Medicare makes the payment so that you won’t have to cover the bill out of pocket. These payments are classified as conditional because they must be repaid if you receive a settlement or judgment at a later date. If Medicare makes a conditional payment, you need to contact the Benefits Coordination & Recovery Center (BCRC). The BCRC will calculate the repayment amount and send you a letter requesting repayment.

  • How Medicare Works with Other Types of Coverage

    If you have any questions about Medicare’s compatibility with other types of coverage, contact the Benefits Coordination & Recovery Center. Also, make sure to notify your doctor and other health care providers about any changes to your policy.

If you have Medicare and group health plan coverage based on your employment status, the group health plan is responsible for the bill.

Medicare acts as the secondary payment provider. It will pay based on the remaining balance and what the doctor has charged on the claim.

If you have an HMO or PPO, you may not be able to receive service outside of your employer plan’s network.

If you are a veteran, you are eligible to receive Medicare and Veterans’ Benefits. Medicare and Veterans’ Benefits cover their own specific services and items. If you need treatment, you have to choose which benefits to use when you are seeing a doctor.

Before you purchase Medicare, it’s a good idea to do your research to know if it is compatible with other types of coverage. If you have any questions concerning Medicare, don’t hesitate to contact us at Medicare Advisors. Our experts will assist you and help you evaluate your options.