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Will Medicare cover orthopedic tempur pedic mattresses?
No not a mattress for a normal bed whether tempur-pedic or otherwise. They will cover 80% of a hospital bed and Tempur-Pedic does make a mattress for this style of bed. With a very specific prescription Medicare may cover 20% of that mattress but you have to pay for it up front and Medicare MAY reimburse you or the provider (like a home health store) the 20%. I just spent 3 days researching this very subject and Medicare will not cover the cost of a "normal" mattress even with a doctor's prescription. By this I mean I have a prescription in my hand that states I need to have a posturpedic firm - extra firm mattress or a Tempur-pedic or other memory foam type mattress, after contacting three different home health companies (they provide hospital beds, replacement hospital bed mattresses, lifts etc.) that all told me they have never heard of Medicare paying for a normal mattress so I decided to contact Medicare directly. I talked to three different people and all of them said the same thing. A hospital bed would be covered if my doctor prescribes one, however no normal mattress is covered for any reason. There are some mattresses and Mattress covers provided for patients with ulcers of the skin etc. but they have to be waterproof and other restrictions apply. For a closer inspection of your own look under Pressure Reducing Support Surfaces - *Group 1 Group 2 and Group 3 At http://www.medicare.gov and you will have to put in your own state and narrow it down from there. *Group 1 is as close as your going to get to a mattress and Medicare will only pay for waterproof mattresses under this group.
Who is the primary payer when member has employee group and medicare?
Generally, Medicare is primary.
What group is delegated the operation of the medicare and medicaid programs?
Medicare Administration Controllers
Can medicare be used for secondary insurance if the primary insurance is paid by your employer?
Medicare is primary if your group is under 20 lives. 20 lives or more and medicare is secondary to your employer paid group plan.
When was the first group coverage emerged in?
medicare
Which group does the Medicare program NOT cover?
prisoners
When a Medicare beneficiary has employer supplemental coverage Medicare refers to these plan as?
large group health plan
When is medicare disability prime over a group health plan?
As long as the only reason you are covered by Medicare is because of a disability and you haven't reached the minimum age Medicare requires to become eligible naturally, then the number of members in the group health plan will determine who is primary or secondary. Group plans with fewer than 100 members are considered to be "small" businesses and Medicare would be primary. Conversely, "large" businesses (more than 100 members) will be primary over Medicare. It doesn't matter whether the group plan is provided by you or your spouse. At the time you reach Medicare's required age to naturally become eligible with them, your case will be reviewed. At that point, the group size doesn't matter. If you have other coverage provided by you or your spouse, it will always be primary over Medicare. Medicare won't become primary until both you and your spouse have retired and are no longer covered by a group health plan. Medicare supplement plans are always secondary to Medicare, but then those aren't group health plans.
Where do you report Medicare fraud?
If you suspect Medicare fraud contact Medicare at 1-800-MEDICARE or visit their website at www.medicare.gov.
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 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.
If a small group is in a PEO is medicare primary or secondary?
Medicare is always the primary insurance unless someone is still working
Can an employer offer to pay Medicare and Medicare Supplement premiums of the Medicare eligible employees and dependents if the employee wants to move off of the employer sponsored group health plan?
no
