Medicare and Medicaid

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?

456

Top Answer
User Avatar
Wiki User
Answered
2010-09-26 01:09:13
2010-09-26 01:09:13

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 benefits 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.

001
๐Ÿ˜‚
0
๐ŸŽƒ
0
๐Ÿคจ
0
๐Ÿ˜ฎ
0
User Avatar

Related Questions


If a provider accepts Medicare they have to accept a standardized supplement. They may not accept a Medicare Advantage or a Medicare Supplement Select plan.


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....


Please explain your question more thoroughly if my answer does not suffice. I am unsure of what you mean by Medicare Carve Out Coverage. You can buy a Medicare Supplement at any time once you have received your Medicare Part A and Part B. If you do not enroll within 6 months of your Part B effective date you would be subject to underwriting. You can not join a Medicare Supplement if you already have a Medicare Advantage Plan as this is not allowed by Centers for Medicare. You would be required to drop your Medicare Advantage Plan prior to the Medicare Supplement effective date. If you had coverage through an employer, you would not need Medicare Supplement coverage as your employer coverage would be primary and then Medicare would be secondary for your out-of-pocket costs covered by Medicare.


http://www.medicaresupplementnews.com/]Medicare Supplement News


Is it to late to apply for a medicare supplement insurance plan


To add, a supplement plan is called a Medigap Insurance policy. It, like Medicare, will not pay for everything but will pick up most of the difference between what Medicare covers and the normal office/procedure charges.


I am not finding an answer to my question---Are the premiums on my medicare supplement tax deductable? Please help!


Prescription plans can be used as a supplement to Medicare. There are medications that are not covered by medicare that a prescription plan can be used as an alternative way to receive them.


Medicare supplements are private insurance plans.


WHEN MEDICARE IS PRIMARY, THE PATIENT IS RESPONSIBLE FOR THE SECONDARY COPAY.


We have Medicare and added on Anthem. Does that mean Medicare is primary (Paying 80 percent) , and Anthem is secondary?


No. There is a federal law that requires Medicare is a secondary payer. You can find more information on the CMS website under "Medicare Secondary Payer and You."


Medicare supplement insurance, sometimes called Medigap, helps cover some of the costs not covered by Medicare. It is purchased from private insurance companies and is different from the Medicare Advantage Plan.


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. They 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.


There are a few benefits to purchasing a Humana Medicare supplement. Humana is a good supplement because it is very worthwhile in one's old age as it provides thorough coverage.


It's the provider's office responsibility to forward the bills to the correct insurance for payment. When using Medicare along with a Medicare Supplement, you'll show both your Medicare Card and your Supplement insurance company's card at time of payment. The provider's office will bill each card accordingly.


AARP Medicare Supplement Insurance picks up the Medicare deductible.


Yes, there are doctors in California that accept medicare supplement insurance. You can see a list of them at www.medicare.gov/mppf/home.asp


The answer to this question depends on what kind of secondary insurance you have - is it a group health plan? Is it a supplement? If Medicare is primary, there are still deductibles, copays, coinsurance that would need to be satisfied by your secondary insurance. Based on your question, I'm assuming that you have a group health plan with a copayment as your secondary insurance. If so, then yes, you would pay your copayment but it would not exceed the part B deductible.


after getting the payment from medicare (Primary) then secondary (X/Y/Insurance should pay even if there is no auth. And only this happens if secondary insurance follow medicare guidelines.


If you already have Medicare Part A and are enrolled in Medicare Part B, you can get a Medicare Supplement. When it comes to having insurance at work, take a look page 16 in the 2009 Medigap Book: http://www.medicare.gov/Publications/Pubs/pdf/02110.pdf


If you are working then medicare is secondary (always)


ZERO! Don't confuse Medicare Advantage with Medicare Supplemental Insurance. It's like confusing the dog with it's terd.


medicare does not covere preventative. you need a HMO/PPO policy or a supplement


Medicare Supplement leads are information packets purchased from companies that give information about patients that will soon be eligible for Medicare. These companies track personal data about individuals and then sell them to interested insurance companies.



Copyright ยฉ 2020 Multiply Media, LLC. All Rights Reserved. The material on this site can not be reproduced, distributed, transmitted, cached or otherwise used, except with prior written permission of Multiply.