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Medicare as a Secondary Payer – Understanding Health Insurance, Part 6

In our last blog entry for our Understanding Health Insurance series, we discussed the general differences between a secondary plan and a supplemental plan. This week, we are taking a look at how it works when Medicare is your secondary payer.

How do you know when Medicare is your Secondary Payer (MSP)?

As we discussed in our last blog post, your primary plan will pay on your insurance claim up to the limits of its policy coverage. Your secondary plan will only pay if there are costs the first plan didn’t cover. Due to the limits of Medicare policies and their allowed amounts, Medicare may not pay for all the remaining costs.

Knowing whether your Medicare coverage is primary or secondary can be difficult, but with the right information, you can navigate the matter with ease. Below is a list of common situations, and the stipulations that determine whether Medicare is your primary or secondary payer for each instance:

Situation: You are 65 or older, still working, and your office has a Group Health Plan (GHP) through which you have coverage.

Answer: If your office has MORE than 20 employees, Medicare is your secondary plan. If your office has FEWER than 20 employees Medicare is your primary.

Situation: You are 65 or older and you are on your spouse’s GHP through his or her job.

Answer: If your office has MORE than 20 employees, Medicare is your secondary payer. If your office has FEWER than 20 employees, then Medicare is your primary.

Situation: You are 65 or older and have an employer retirement plan.

Answer: Medicare is your primary.

Other helpful information about Medicare

Keep in mind that your primary insurance plan may not always pay first. If your health insurance plan doesn’t pay the medical claim in a timely manner (about 120 days after receiving it), your medical office can bill Medicare. They may choose to make a conditional payment and then recover that money from the primary insurer that should have paid first.

We’re here to help

To ensure your medical claims are billed and paid correctly, make sure to tell your doctor and all health care providers about all of your health insurance coverage. Feel free to call – we’re always happy to answer any questions about your insurance.

If you are struggling with chronic or intermittent knee pain that is affecting your daily life, call to schedule an appointment with one of our specially trained physicians today at (503) 719-6783.