Medicare 411 – How Medicare Works with Other Insurance

Medicare 411 – How Medicare Works with Other Insurance

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Greg Dill
Courtesy: Medicare

Greg Dill is Medicare’s regional administrator for Hawai‘i, California, Nevada, Arizona and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

If your family is anything like mine, everyone has a role to play or a responsibility in keeping the household running.

Since I wash dishes faster than anyone else, I’m the designated dishwasher. I’m also responsible for paying our medical bills. My wife and I have separate health plans, so I have to make sure that our providers have the up-to-date information they need to accurately bill our respective insurance plans.

If you have Medicare as well as other insurance, always be sure to inform your doctor, hospital and pharmacy. This is important because it will determine whether your medical bills will be paid correctly and on time.

When there’s more than one insurance payer, certain rules determine which one pays first. These rules are called “coordination of benefits.”

The “primary payer” pays what it owes on your bills first — and then sends the balance to the “secondary payer” to pay. In some cases, there may also be a third payer.

Medicare is the primary payer for beneficiaries who are not covered by other types of health insurance.

The primary payer pays up to the limits of its coverage. The secondary payer only pays if there are costs the primary insurer did not cover.

Keep in mind, however, that the secondary payer (which may be Medicare) may not pay all of the uncovered costs.

If you currently have employer insurance and it is the secondary payer, you may need to enroll in Medicare Part B before your job-based coverage will pay. (Most people who sign up for Part B for the first time this year will pay a monthly premium of $134.)

Here’s who pays first in various situations when you have Medicare and some other type of insurance, as well:

If you have retiree insurance (coverage from a former job), Medicare pays first.

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