What would you like to do?
When a Medicare beneficiary has employer supplemental coverage Medicare refers to these plan as?
large group health plan
Was this answer useful?
Thanks for the feedback!
Yes but the supplement won't pay anything then.
very first medicare beneficiary was Harry S. Truman, the thirty-third President of the United States
Medicare supplemental insurance plans offer coverage for things Medicare may not cover on its own. This extra coverage will allow one to obtain better healthcare at a lower c…ost.
The best place to find this information is found on the medicare website. You can get plan information and make comparisons for all types of coverage.
The answer is really based on an individuals personal circumstances. Each type of coverage has various pro's and con's. The biggest difference is that a Medicare Supplement i…s a supplement to Original Medicare. Original Medicare rules and coverages apply and then the Medicare Supplement plan covers all or a portion of the beneficiary's responsibility and may provide additional benefits that Medicare doesnt cover. This gives you the most choice because you can go to any Medicare provider with no prior authorization in the U.S., but there is a monthly premium. A Medicare Advantage Plan which can be an HMO, PPO, PFFS or several other types of plans, offered by private companies, becomes the primary payor if you enroll in their plan. They may offer little or no monthly premium, but the beneficiary must stay within the network of contracted providers in order to get the most benefits out of plan. In addition, the plan often provides additional benefits that Original Medicare doesnt cover such as vision, dental, & gym memberships. You may save money with this plan, but you have to follow the rules of the plan and stay in-network for coverage, unless an out-of-network benefit is provided.
Medicare supplement pays part or all of your deductibles and copays that you have with Medicare parts A and B. A "Medicare replacement" is actually Medicare advantage. The…y are a Medicare option that combines your Part A, B and sometimes part D into one plan that is administered by a Medicare contracted insurance company. Many of these plans have very low or even 0 monthly premiums. You still have copays but they are generally much less than Original Medicare. (If this question relates to United States Medicare, there is no such thing as the concept of "Medicare replacement." I do not see anywhere to add an alternative answer so I put this here just as a warning. In the United States you are either on Medicare or you are not. If you are on Medicare in the United States, you will almost certainly feel the need to supplement it. Over 95% of the people on United States Medicare supplement it in some way. There is a wide choice of ways to supplement United States Medicare. The answer above describes only two of them.
The "best" Medicare coverage depends on your individual medical needs. In other words the best plan for you may be a bad plan for someone else. Medicare regulates the plans of…fered by the companies, so no company is really better than another. As far as the "cheapest" there is competition between companies on prices, but it really depends on the county and state where your reside, and what type of plan you choose as to what your actual cost will be. A Medicare Advantage Plan basically replaces your use of Traditional Medicare. You still must pay your Medicare Part B premium that is automatically deducted from your Social Security check, that will not stop when you purchase the Medicare Advantage Plan. The following types of Medicare Advantage plans are available, but not always available depending on your county and state of residence: HMO Pros can be zero or very low cost to you per month, predictable co-pays like $10.00 or $15.00 for doctor's office visits, and lower cost hosptilization than Traditional Medicare, no deductibles, and most will include your Medicare Part D Prescription Plan. Cons can be a restricted network of doctors that you must use, no maximum out of pocket limits, and some plans may resort to the old "referrals" to see a specialist. PPO Pros can be low cost to you per month, predictable co-pays like $15.00 or $20.00 for doctor's office visits, you can go in or out of network, no deductibles when you stay in network, no referrals for specialist, lower cost hosptilization than Traditional Medicare, an established maximum out of pocket, and most will include your Medicare Part D Prescription Plan. Cons can be if you do go out of network you'll pay a deductible first before the cost is split by a percentage between you and the insurance company. PFFS This is a "Private Fee For Services" Plan. First the Cons: The single most important thing to remember about PFFS is the fact that you must contact the doctor or hospital FIRST to see if they take the plan. Even before you make an appointment to see a doctor, the doctor must tell you that they do indeed accept the terms and conditions of the plan. The pros are similar to the PPO, it works basically the same. The monthly premiums are typically higher than the PPO, but less than adding a supplement. ONE_MORE_THING!">ONE MORE THING! Now, there are pros and cons when comparing the Medicare Advantage Plans to Traditional Medicare with Medigap, or a Medicare Supplement attached to it. Medigap, also called a Medicare Supplement, basically pays the portion of medical expenses that Medicare expects you to pay. Medicare is an "80/20" plan, meaning Medicare pays 80% of the bill and you pay 20% of the bill. Medigap can pay the 20% for you. Depending on which Medigap plan you choose, the plan can also pay the (2009) $1068.00 hositalization deductible for you and the $135.00 doctor's office deductible for you. Medigap plans have a monthly premium range anywhere between $80.00/month to $300.00/month, depending on your zip code. Medicare Supplement Plan F is considered "the Cadillac plan" as it covers almost everything that Medicare, itself, does not cover. This is also the most expensive Medigap plan. Medicare Supplement Plan G is often 10% lower in cost than Plan F and is exactly the same as F, except that the member must first pay their Medicare Part B deductible each year when seeing the physician for the first time. For 2011, this deductible is $162 for the year. The savings for going with Plan G are often in the $150 to $300 per year range. This means that Plan G is often the best choice for value. Medigap (Medicare Supplement) plans are all standardized, meaning that they are the same, exact, plans from company to company. The only difference is the amount of premium each company charges for the same coverages. Claims cannot be individually denied and are paid based on whether or not they were Medicare-approved claims. That is the only criteria.
I understand when Medicare is primary and when Medicare is secondary. What is the difference in coverage between a Medicare Supplement and Medicare as a secondary insurer?
If you have a Medicare Supplement then the provider will bill Original Medicare first. At that time Medicare will pay the allowable amount and then return an explanation of be…nefits stating the beneficiary's portion. Based on the Medicare Supplement Plan that is in place (A-N) the Medicare Supplement will pay a portion or all of the remaining amount due. If they pay only a portion based on the plan (A-N), then according the plan guidelines, the beneficiary would pay any outstanding amount at that time. If a Medicare beneficiary is covered on a employer or retiree group plan and due to the size of the plan, the group plan is primary, then the group plan benefits will apply first and any amounts due by the Beneficiary will be billed to Medicare second. If it is a Medicare covered service, then Medicare will pay the remaining amount due as the secondary payor up to the amount allowed by Medicare. If the service is not allowed by Medicare, than the beneficiary's co-insurance or co-payment under the group plan would be their responsibility.
As a former nursing home Social Services and Admissions director and current hospital employee I would not recommend going on a medicare replacement policy. Insurance companie…s are for profit and will fight to cut your benefits short to save themselves money. I have seen many patients denied services or have nursing home or hospital stays cut short because of this. They can also limit your options when it comes to which nursing homes and doctors are "in Network" sometimes leaving you with second rate care.Type your answer here...
Yes. It depends on what is covered in your Medicare plan. There are supplemental insurance programs, like MediGap and other additional options provided either by Medicare itse…lf, or by your own choice of providers. This answer is correct for the most part, but you don't HAVE to have a supplement when you have Medicare. It is up to you. Most people wouldn't go without a supplement. These nifty little plans can cover your deductibles and coinsurances that Medicare leaves for the patient. If your claim is high dollar, you could find yourself in trouble trying to figure out how to pay your portion of the bill. Also, Medicare itself doesn't offer any supplemental insurance. You have to shop for yourself and decide which sounds like it would help you the most. Part D supplemental coverage is for prescriptions. Medicare does not cover any prescriptions. You have to figure which drugs you are presently taking and then find a supplement that will cover most of those drugs. If your prescriptions radically change over the year, you may want to shop for a new Part D supplement when it's the time of year to add, delete or change your supplements or even purchase a Medicare Replacement Plan. Many, many choices.
Medicare Dental Coverage Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw f…ollowing accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Medicare will also make payment for oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement, under certain circumstances. Such examination would be covered under Part A if performed by a dentist on the hospital's staff or under Part B if performed by a physician. Statutory Dental Exclusion Section 1862 (a)(12) of the Social Security Act states, "where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services." Background The dental exclusion was included as part of the initial Medicare program. In establishing the dental exclusion, Congress did not limit the exclusion to routine dental services, as it did for routine physical checkups or routine foot care, but instead it included a blanket exclusion of dental services. The Congress has not amended the dental exclusion since 1980 when it made an exception for inpatient hospital services when the dental procedure itself made hospitalization necessary. Coverage Principle Coverage is not determined by the value or the necessity of the dental care but by the type of service provided and the anatomical structure on which the procedure is performed. Services Excluded under Part B The following two categories of services are excluded from coverage: A primary service (regardless of cause or complexity) provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth, e.g., preparation of the mouth for dentures, removal of diseased teeth in an infected jaw. A secondary service that is related to the teeth or structures directly supporting the teeth unless it is incident to and an integral part of a covered primary service that is necessary to treat a non-dental condition (e.g., tumor removal) and it is performed at the same time as the covered primary service and by the same physician/dentist. In those cases in which these requirements are met and the secondary services are covered, the Medicare payment amount should not include the cost of dental appliances, such as dentures, even though the covered service resulted in the need for the teeth to be replaced, the cost of preparing the mouth for dentures, or the cost of directly repairing teeth or structures directly supporting teeth (e.g., alveolar process). Exceptions to Services Excluded The extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease. An oral or dental examination performed on an inpatient basis as part of comprehensive workup prior to renal transplant surgery or performed in a RHC/FQHC prior to a heart valve replacement. Definition Structures directly supporting the teeth means the periodontium, which includes the gingivae, periodontal membrane, cementum of the teeth, and the alveolar bone (i.e. alveolar process and tooth sockets).
Medicare supplemental insurance is insurance that helps cover some of the healthcare cost that the original medicare doesn't cover. This type of insurance also covers certain …policies that the original medicare itself doesn't cover such as being ill when outside of the US.
Medicare supplements are private insurance plans.
ZERO! Don't confuse Medicare Advantage with Medicare Supplemental Insurance. It's like confusing the dog with it's terd.
6 months prior and 6 months after your Medicare Part B effect month is your guaranteed issue period. During that time you can join a Medicare supplement plan without answering… health questions. After that time period you can join a supplement plan at any time but you may be subject to the companies health underwriting. In some states United of Omaha offers the Plan N on a guaranteed basis for anyone over age 65 with Medicare A & B.
You will bill medicare as primary and the supplement secondary. Usually if filing a HCFA 1500 electronically if the supplemental policy is on the beneficiaries Common Working …File with Medicare it will automatically crossover to the supplemental policy. Hope this helps....