Tuesday, September 27 , 2016, 4:32 pm | Fair 84º

  • Follow Noozhawk on LinkedIn
  • Follow Noozhawk on Pinterest
  • Follow Noozhawk on YouTube
 
 
 
Your Health

David Sayen: How Medicare Works with Other Insurance

It’s an important issue because it determines whether your medical bills are paid correctly and on time.

David Sayen
David Sayen

If you have Medicare and other insurance, always be sure to tell your doctor, hospital and pharmacy.

When there’s more than one insurance payer, certain rules determine which one pays first. This is what’s called “coordination of benefits.”

The “primary payer” pays what it owes on your bills first — and then sends the balance to the “secondary payer” to pay.

In some cases, there may also be a third payer.

The primary payer pays up to the limits of its coverage. The secondary payer only pays if there are costs the primary insurer didn’t cover.

But keep in mind that the secondary payer (which may be Medicare) may not pay all of the uncovered costs.

If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before that insurance will pay. (The Part B premium for most Americans in 2013 is $104.90 per month.)

Here’s who pays first in various situations:

If you have retiree insurance (coverage from a former job), Medicare pays first.

If you’re 65 or older, have group coverage based on your or your spouse’s current employment, and the employer has 20 or more workers, your group plan pays first. (If the company has fewer than 20 employees, Medicare pays first.)

Your group plan also pays first when you’re under 65 and disabled, have group coverage based on your or a family member’s current employment, and the employer has 100 or more employees. (Medicare pays first if the company has fewer than 100 employees.)

If you have Medicare because of end stage renal disease (permanent kidney failure), your group plan pays first for the first 30 months after you become eligible for Medicare. Medicare pays first after this 30-month period.

Medicare may pay second if you’re in an accident or have a workers’ compensation case in which other insurance covers your injury or you’re suing another entity for medical expenses.

In these situations you or your lawyer should tell Medicare as soon as possible. These types of insurance usually pay first for services related to each type:

» No-fault insurance (including automobile insurance)

» Liability (including automobile and self-insurance)

» Black lung benefits

» Workers’ compensation

Medicaid and Tricare (the health-care program for U.S. armed service members, retirees and their families) never pay first for services that are covered by Medicare. They only pay after Medicare, employer plans and/or Medicare Supplement Insurance (Medigap) have paid.

Click here for more information and to read the booklet “Medicare and Other Health Benefits: Your Guide to Who Pays First.”

You can also call 800.633.4227 and ask for a copy to be mailed to you. TTY users should call 877.486.2048.

If you have questions about who pays first, or you need to update your other insurance information, call Medicare’s coordination of benefits contractor at 800.999.1118. TTY users should call 800.318.8782.

You can also contact your employer or union benefits administrator. You may need to give your Medicare number to your other insurers so your bills are paid correctly and on time.

— David Sayen is Medicare’s regional administrator for California, Arizona, Hawaii, Nevada and the Pacific Trust Territories. You can always get answers to your Medicare questions by calling 800.MEDICARE (633.4227).

Reader Comments

Noozhawk's intent is not to limit the discussion of our stories but to elevate it. Comments should be relevant and must be free of profanity and abusive language and attacks.

By posting on Noozhawk, you:

» Agree to be respectful. Noozhawk encourages intelligent and impassioned discussion and debate, but now has a zero-tolerance policy for those who cannot express their opinions in a civil manner.

» Agree not to use Noozhawk’s forums for personal attacks. This includes any sort of personal attack — including, but not limited to, the people in our stories, the journalists who create these stories, fellow readers who comment on our stories, or anyone else in our community.

» Agree not to post on Noozhawk any comments that can be construed as libelous, defamatory, obscene, profane, vulgar, harmful, threatening, tortious, harassing, abusive, hateful, sexist, racially or ethnically objectionable, or that are invasive of another’s privacy.

» Agree not to post in a manner than emulates, purports or pretends to be someone else. Under no circumstances are readers posting to Noozhawk to knowingly use the name or identity of another person, whether that is another reader on this site, a public figure, celebrity, elected official or fictitious character. This also means readers will not knowingly give out any personal information of other members of these forums.

» Agree not to solicit others. You agree you will not use Noozhawk’s forums to solicit and/or advertise for personal blogs and websites, without Noozhawk’s express written approval.

Noozhawk’s management and editors, in our sole discretion, retain the right to remove individual posts or to revoke the access privileges of anyone who we believe has violated any of these terms or any other term of this agreement; however, we are under no obligation to do so.

Support Noozhawk Today

You are an important ally in our mission to deliver clear, objective, high-quality professional news reporting for Santa Barbara, Goleta and the rest of Santa Barbara County. Join the Hawks Club today to help keep Noozhawk soaring.

We offer four membership levels: $5 a month, $10 a month, $25 a month or $1 a week. Payments can be made through PayPal below, or click here for information on recurring credit-card payments.

Thank you for your vital support.



 

Special Reports

Heroin Rising
<p>Lizette Correa shares a moment with her 9-month-old daughter, Layla, outside their Goleta home. Correa is about to graduate from Project Recovery, a program of the Santa Barbara Council on Alcoholism & Drug Abuse, and is determined to overcome her heroin addiction — for herself and for her daughter. “I look at her and I think ‘I need to be here for her and I need to show her an example, I don’t want her to see me and learn about drugs’,” she says.</p>

In Struggle to Get Clean, and Stay That Way, Young Mother Battles Heroin Addiction

Santa Barbara County sounds alarm as opiate drug use escalates, spreads into mainstream population
Safety Net Series
<p>Charles Condelos, a retired banker, regularly goes to the Santa Barbara Neighborhood Clinics for his primary care and to renew his prescription for back pain medication. He says Dr. Charles Fenzi, who was treating him that day at the Westside Clinic, and Dr. Susan Lawton are some of the best people he’s ever met.</p>

Safety Net: Patchwork of Clinics Struggles to Keep Santa Barbara County Healthy

Clinics that take all comers a lifeline for low-income patients, with new health-care law about to feed even more into overburdened system. First in a series
Prescription for Abuse
<p>American Medical Response emergency medical technicians arrive at Santa Barbara Cottage Hospital with little time to spare for victims of prescription drug overdoses.</p>

Quiet Epidemic of Prescription Drug Abuse Taking a Toll on Santa Barbara County

Evidence of addiction shows an alarming escalation, Noozhawk finds in Prescription for Abuse special report
Mental Health
<p>Rich Detty and his late wife knew something was wrong with their son, Cliff, but were repeatedly stymied in their attempts to get him help from the mental health system. Cliff Detty, 46, died in April while in restraints at Santa Barbara County’s Psychiatric Health Facility.</p>

While Son Struggled with Mental Illness, Father Fought His Own Battle

Cliff Detty's death reveals scope, limitations of seemingly impenetrable mental health system. First in a series