Medicare Advantage Embedded Dental considered in employer 1st payer priority?

yorkriver1

Guru
1000 Post Club
1,735
Virginia
A large employer group is the first payer for medical expenses that Medicare covers, if the employee has both employer and Medicare coverage. If the employee has dropped medical coverage and keeps the large group dental and vision coverage, I would assume there would be similar rules about primary/secondary?
I bring this up because the broker service rep for the new MAPD carrier thought maybe the employer plan would find some kind of conflict there.
 
my understanding the dentist office will first file whatever plan they last filed for patient first then when that is exhausted they start billing the mapd with that said i have seen a dentist office file claims for an individual dental ppo and a mapd for same services.My dentist office who sometimes gives me referrals doesn't even know for sure.
 
my understanding the dentist office will first file whatever plan they last filed for patient first then when that is exhausted they start billing the mapd with that said i have seen a dentist office file claims for an individual dental ppo and a mapd for same services.My dentist office who sometimes gives me referrals doesn't even know for sure.
That makes sense, and if the employer or other plan besides the MAPD dental is a PPO those can (depending on the contract I suppose) pay regardless of other coverage. Then, too, sometimes the MAPD dental is a PPO that "just pays". I wonder if the Medicare service rep I mentioned was thinking of small employer groups size 19/under where Medicare is primary by law. Over that group size, the employer plan is primary, but I still think dental probably isn't part of that.
 
Back
Top