If you already have some form of insurance coverage, but will soon become eligible for Medicare, you may be concerned about how Medicare benefits will interact with your other coverage. In most cases, you can have Medicare and another insurance policy at the same time, but some restrictions may apply to how benefits are paid out. Here is what you need to know about combining Medicare benefits with other policies.
Coordination Of Benefits
The order in which health care providers bill your insurance companies is decided during the “coordination of benefits”. The insurance that pays first is called the primary payer, while the company to pay second is deemed the secondary payer. Medicare may be in either category, depending on the circumstances.
If your alternative insurance does not pay their share of a bill within a set timeframe of around 120 days, your hospital may send the bill to Medicare instead. It is possible that Medicare will pay bills in this situation and look to recoup the costs from the primary payer later.
As mentioned in the previous section, Medicare will sometimes pay for services that other payers on the account were responsible for. Medicare does this so that the beneficiary won’t have to use their own funds to pay the bills. These payments are considered “conditional” because Medicare will be making an effort to collect the amount if you get any settlements, payments, or awards to cover that cost later.
Basic Medicare Benefits Coordination Rules
The rules for which insurance company will pay first varies based on a variety of metrics. For example, if your non-Medicare insurance is an employer-sponsored group health plan, the size of your employer may factor into its payer status. In fact, companies with 20 or more employees are likely to have group plans that pay first, leaving Medicare to pay second. Other situations may warrant Medicare paying first, such as a Veteran receiving care outside of a VA facility. The rules become very complex, so work with an insurance agent to clearly determine how your insurance policy will interact with Medicare benefits.
We’ll Help You Find the Right Medicare Coverage
If you need to know how your current insurance policy will work once you enroll in Medicare, an insurance agent can break it down for you. The experts at Trusted Senior Specialists will help you learn everything you need to know about Medicare. Contact us now to schedule an insurance consultation and policy review.