Medicare and Coordination of Benefits

Medicare and Coordination of Benefits




So you have Medicare but are enrolled in Group Retiree Benefits, or some other type of coverage in addition to Medicare. That’s great, but who covers first, who comes in second. Do you know?



Don’t worry most people don’t know. I remember not to long ago, answering these same questions, on the telephone, and this sweet lady was so upset, because no one took the time to explain it to her.



Keep in mind, this information can be found in the “ MEDICARE AND YOU 2010 Book. The book itself has a little over 135 pages.



So Who pays first when you have other insurance????



When you have other insurance( like employer group health coverage) There are rules that decide whether Medicare or your other insurance pays first. The insurance that pays first is called “primary payer” and pays up to the limits of its coverage. The one that pays second, called the “secondary payer” only pays if there are costs left uncovered by the primary coverage.



If your other coverage is from an employer or union group health plan, these rules apply:

• If you are retired, Medicare pays first

• If your group health plan coverage is based on your or a family member’s current employment, who pays first depends on your age, the size of the employer, and whether you have Medicare based on age, disability, or End-Stage Renal Disease ( ESRD):

- If you are under age 65 and disabled, your plan pays first if the employer has 100 or more employees or at least one employer in a multiple employer plan has more than 100 employees.

- If you are over age 65 and still working, your plan pays first if the employer has 20 or more employees or at least one employer in a multiple employer plan has more than 20 employees.

• If you have Medicare because you have ESRD, your plan pays first for the first 30 months you have Medicare.



The following types of coverage usually pay first:

• No-fault insurance ( including automobile insurance)

• Liability ( including Automobile insurance)

• Black Lung benefits

• Workers’ Compensation

Medicaid and TRICARE never pay first. They only pay after Medicare, employer group health plans, and/or Medigap have paid.



This is very important!!!!!!!!!!!!!!!!!!!

If you have other coverage, tell your doctor, hospital and or pharmacy. If you have questions about who pays first, or you need to update your other insurance information, call Medicare’s Coordination of Benefits Contractor at 1-800-999-1118. TTY users should call 1-800-318-8782.



You may need to give your Medicare number to your other insurers ( once you have confirmed their identity) so your bills are paid correctly and on time.



I hope this clears up some of the confusion about who pays, when and why.



And remember if there is something that you would like me to find out for you, leave a comment and/or email me at mmcampos68@gmail.com