Quick Question

[RABBI]

So can a beneficiary have a Medicare Health plan thru their former employer (primary) AND Medicare A&B (secondary). How does this work because she said she travels and the hospital in FL didn't take her health plan. Would medicare then pay because they are secondary?? Tried to search but couldn't find any info for this scenario. Thanks

 

[insuranceconceptscindy]

Yes. One would be primary and the other secondary. If she has group coverage through an employer with more than 20 employees, Medicare would be secondary. Medicare MAY pay a little bit of the claim, but the majority of it would be paid through the group plan. If the provider does not accept the group plan, they couldn't bill only Medicare- it has to go through primary first and then secondary.

 

[RABBI]

Ok thanks Cindy. Where did you find info on employer groups with 20 or more people? I have read through the Medicare & you but employer situations some times can be funny.

 

[TwoCents]

Ok thanks Cindy. Where did you find info on employer groups with 20 or more people? I have read through the Medicare & you but employer situations some times can be funny.

Search for coordination of benefits.

 

[WCMason]

So can a beneficiary have a Medicare Health plan thru their former employer (primary) AND Medicare A&B (secondary). How does this work because she said she travels and the hospital in FL didn't take her health plan. Would medicare then pay because they are secondary?? Tried to search but couldn't find any info for this scenario. Thanks

If this were active employment the EGHP would be primary--assuming the 20+ employee rule--but not for a retiree or formerly employed EGHP as you've described. Medicare is primary.

 

[DS4]

Where did you find info on employer groups with 20 or more people?

Medicare Secondary Payer - Centers for Medicare & Medicaid Services

 

[RABBI]

Thanks soo much for the responses. She says she has allied benefits as primary and medicare secondary. She is really confused. Sounds like she went thru an exchange and they set her up with a MAPD because she travels and said her plan didn't work when she used it in FL. She is digging out her plan so we can get to the bottom of it.

 

[WCMason]

Thanks soo much for the responses. She says she has allied benefits as primary and medicare secondary. She is really confused. Sounds like she went thru an exchange and they set her up with a MAPD because she travels and said her plan didn't work when she used it in FL. She is digging out her plan so we can get to the bottom of it.

Well I can definitely believe that an exchange rep would leave her believing that a Medicare Advantage plan she signed up for is primary with Medicare being secondary to it.

 

[jbage007]

Thanks soo much for the responses. She says she has allied benefits as primary and medicare secondary. She is really confused. Sounds like she went thru an exchange and they set her up with a MAPD because she travels and said her plan didn't work when she used it in FL. She is digging out her plan so we can get to the bottom of it.

that makes no sense at all

 

[RABBI]

that makes no sense at all

Tell me about it. She pays $800 month and doesnt know what it goes too