| <!-- @page { size: 8.5in 11in; margin: 0.79in } P { | | | | payer. |
| margin-bottom: 0.08in } A:link { color: #0000ff } | | | | Rules on Whether Medicare is First or Second Payer |
| --> | | | | So who pays first all depends on your current |
| Coordination of Benefits When You Have Medicare | | | | insurance coverage, whether you're working or |
| Probably one of the most confusing things about | | | | retired and your age. There are many scenarios that |
| health insurance, with or without Medicare coverage, | | | | dictate whether Medicare is the first or second |
| is when you have more than one insurance plan and | | | | payer; however, here are some of the more |
| want to understand who pays your medical bills. | | | | common situations. Keep in mind you are not eligible |
| While it is difficult to anticipate each and every | | | | for Medicare unless you are 65 or older or disabled. |
| situation, there are some basics that can help you | | | | |
| understand how Medicare and other insurance | | | | If you have other coverage from an employer (your |
| benefits coordinate their efforts. | | | | own or your spouse's), are over the age of 65 AND |
| Understanding How Payers Coordinate Benefits | | | | You are retired, Medicare pays first |
| Every type of insurance coverage you have – | | | | The employer has less than 20 employees, Medicare |
| group health plan coverage, Medicare, Medicare | | | | generally* pays first |
| Supplement Insurance – is designated as a | | | | The employer has 20+ employees, the employer |
| "payer." When there is more than one payer, there | | | | pays first |
| are rules concerning the coordination of benefits | | | | You are disabled and the employer has less than 100 |
| which decides who pays first, who pays second and | | | | employees, Medicare pays first |
| so on. The primary payer will pay what it owes up to | | | | You are disabled and the employer has 100+ |
| the limits of its coverage. The bill will then be | | | | employees, the employer pays first |
| forwarded to the secondary payer to pay for any | | | | *If your employer participates in a plan that is |
| costs uncovered by the primary payer. In some rare | | | | sponsored by two or more employers, the rules are |
| cases, there may even be a third payer. | | | | slightly different. |
| "Be sure to notify your physician if you have | | | | In addition, generally the following types of coverage |
| Medicare Supplement Insurance," advises Alan | | | | pay first: no-fault insurance (including automobile |
| Weinstock, insurance broker at "It's easy to think | | | | insurance), liability (including automobile insurance), |
| that Medicare will cover most of your needs and | | | | black lung benefits and workers' compensation. |
| forget that your Medigap coverage is there to cover | | | | Medicaid and TRICARE only pay after Medicare, |
| the gaps." | | | | employer group health plans and/or Medigap have |
| Whether Medicare is your primary or secondary | | | | paid. |
| payer depends on several things. However, it is | | | | Understanding how your plans coordinate to give you |
| always important to advise your doctor and other | | | | complete health coverage is important to your peace |
| medical providers about all the insurance coverage | | | | of mind. You can contact Medicare at 1-800-633-4227 |
| you have in order to help them coordinate your bills | | | | with further questions. |
| and to ensure they are submitted to the correct | | | | |