How Do You Determine If Medicare is Primary or Secondary?

Medicare MAY NOT be the PRIMARY PAYER on health care claims. A person’s employment status and diagnoses can affect who is responsible for PRIMARY OR SECONDARY payments.

Once you are eligible for Medicare and enroll in its program, there is no way for them to know whether you have other health insurance coverage or not. You will be sent a form to complete giving them this pertinent information. It is important that you advise them of any other coverage you may have so that they can work with your other insurance, if applicable, to make sure your claims are paid correctly. This process is referred to as “coordination of benefits”. Whoever is primary pays the part of your bill that they are responsible for, as long as it is a covered expense, and then the secondary insurance pays their part as well. A third party can also be involved in some instances.

Types of Coverage

There are several of different types of coverage. Depending on an individual’s status such as disabled, active military, military veteran, employed, retired, accidental injury (liability) claim, will help determine which insurance program is the primary payer. These are just a few that determine an individual’s eligibility and what his/her benefits are. In certain situations a diagnosis such as End-Stage Renal Disease also plays a part in determining who the primary and secondary payers when there is a health care issue. Not all situations of illness can be listed in this article.

Keeping An Updated Status

It is urgent that you notify Medicare if your status changes so that it can be entered into your file. This will ensure that your health claims are being handled properly. It is also necessary when receiving care, to update any providers so they can update your file in their respective offices. In the event that you’re not sure who pays first, you can check your insurance policy for the information. You also can call the Medicare Coordination of Benefits Contractor who should be able to any any questions you may have.

Related posts

1. When Is Medicare Coverage Primary And Secondary?
2. Can Private Health Plans Reduce My Medicare Benefits?
3. When Is Medicare Secondary?
4. Which Plan Is Primary Under Medicare Part D?
5. Is Medicare Supplement Insurance (Medigap) Really Worth the Cost?

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