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Medicare And Other Health Insurances: How Does It Work?

Medicare And Other Health Insurances

In many cases having coverage from more than one source can supplement the payments that you have to make. Those who are covered by Veteran’s Affairs or through any other group insurance policy can enroll into Medicare to get more coverage than they did from either in isolation. Through plans such as these, you can make sure that you significantly reduce the medical cost burdens you have taken on.

Having more than one type of coverage can introduce some complications that you might need to watch out for. These may change the premium rates you pay, change the types of coverage your insurer offers and might also become difficult to keep track of the payments you have to make.

Payers

Payers

When you have more than one insurer covering your costs, multiple companies then start paying for different parts of your expenses. Usually people have at most two parties paying for their expenses; however in some cases there might even be three.

Depending on the rules dictating the coordination of payments, each of the three parties can arrange themselves as priority payers for your claims.

The primary payer is the first party to offer up payment for your claims. These generally offer coverage until it runs out. At which point the secondary payer begins covering the remaining expenses. This process goes on until your expenses are fully covered or until coverage from each entity runs out.

Conditional Payments

Conditional Payments

Sometimes your secondary payers may refuse to make any payments on your behalf. This could be for a number of reasons, such as pending dues or your services do not lie within coverage.  Although this is rare, when you combine other types of coverage with Medicare, Medicare will conditionally cover your costs.

This implies that although Medicare will cover the expenses, it will only do so as long as you make sure the Medicare is repaid for the extra money they paid out.

Insurance Providers Who Pay first

Insurance Providers Who Pay first

Although Medicare covers a major chunk of your healthcare expenses, it is better to have expended all of your other coverage plans before Medicare kicks in.  This is advised in situations where Medicare doesn’t cover all of the services that you require or to avoid complications associated with the implementation of Medicare plans (Doctors might not be Enrolled; you might need to switch plans etc.)

Depending on the nature of treatment you require, Medicare or your other coverage plans may take priority on payments. A few examples of this are:

  • If an employer has more than 20 employees, they take first priority
  • If you are disabled, barring ESRD, Medicare takes priority
  • If an employer has less than 20 employees , Medicare makes first payments

The full set of guidelines can be found here.

Seniors for Medicare is a premium Medicare advisory firm that has been serving the people of New Jersey and New York since 2009. Our consultants have vast experience in helping our clients pick out the ideal Medicare Health plan for their needs. Call us today or book an appointment with our licensed consultants or for more information on our services.

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