Posted May.02, 2013 in Medicare
Many people in the Medicare program may find themselves lost in a maze of paperwork and unanswered questions. On occasion we post helpful information from Medicare’s website. The Medicare website provides a wealth of information to those that need help understanding the many facets of how Medicare works. Below you will find information about how Medicare works with other insurances. Over the next couple of weeks we will share additional information from the Medicare website regarding conditional payments. We hope you find this information beneficial. To find more useful tools from Medicare, click here to visit their site.
If you have Medicare and other health insurance or coverage, each type of coverage is called a “payer.” When there’s more than one payer, “coordination of benefits” rules decide which one pays first. The “primary payer” pays what it owes on your bills first, and then sends the rest to the “secondary payer” to pay. In some cases, there may also be a third payer.
What it means to pay primary/secondary
- The insurance that pays first (primary payer) pays up to the limits of its coverage.
- The one that pays second (secondary payer) only pays if there are costs the primary insurer didn’t cover.
- The secondary payer (which may be Medicare) may not pay all the uncovered costs.
- If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.
Paying “first” means paying the whole bill up to the limits of the coverage. It doesn’t always mean the primary payer pays first in time. If the insurance company doesn’t pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should’ve made.
If you have questions about who pays first, or if your insurance changes, call the Medicare Coordination of Benefits Contractor.
Note: Tell your doctor and other health care providers if you have coverage in addition to Medicare. This will help them send your bills to the correct payer to avoid delays.