How does Medicare work with other kinds of insurance?

December 13, 2016

If you are a Medicare beneficiary, you can still have health insurance coverage plans in addition to Medicare.  These could be Plans that have been offered to you by your employer, or Plans you choose to buy other than Medicare.  And any of these could be your primary insurance plan.

If you have multiple health insurance coverage plans, coordination of benefits rules decide which one pays first and for what.  Coordination of benefits determines which payer will pay for a health service or need in the case where all of them provide coverage for that need.

The primary payer will usually pay what it owes on your bills first, and then sends the rest to the secondary payer.  The primary payer is the insurance plan that pays first, up to the limits of its coverage.  The secondary payer only pays if there are costs the primary payer does not cover, or did not cover due to coverage limits in terms of cost or benefits.  The secondary payer, however, may not pay for the entire leftover bills.  In such cases, you may have a third payer.

The primary payer may not always pay first.  In some cases, when the primary payer is not able to pay for a certain number of days (usually 120 days), your doctor will bill the second payer.  In the case where the second payer is Medicare, it may make a conditional payment to pay the bill, and then later recover payments from the primary payer.  The Benefits Coordination and Recovery Center (BCRC) is responsible for coordinating these payments and settlements.  It will gather information about conditional payments, calculate the repayment amount, and send you a letter requesting repayment.  You are responsible for making sure Medicare gets repaid for the payment made.  You can usually report your settlements to Medicare yourself, or with the help of a lawyer.

You can contact BCRC at 1-855-798-2627 for queries related to payers, payments, and repayments.  You can also contact Medicare or Medigap for plan-specific queries.

Note: Always tell your doctor about your payers.  This will help them send your bills to the correct payer to avoid problems and delays.

This is not a complete description of Medicare or how it works with other kinds of insurance.  For more information and to speak with a Medicare specialist, contact Medigap, Inc. at 1-855-214-4404.


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