Medicare is generally the secondary payer if your employer has 20 or more employees. How Medicare works with your employer-sponsored plan depends on the size of your company. If you’re over 76 and eligible for Medicare but aren’t yet retired, you can use Medicare along with your company’s health plan. Some common scenarios are explained here: Medicare and employer-sponsored healthcare plans The rules for using Medicare with each type of insurance are a little different. For example, if you still have insurance coverage from your job, military benefits, or another source, Medicare will be the primary payer and your other insurance will become the secondary payer. There are a couple of common situations when you might have a secondary payer alongside Medicare. Depending on what plans are available in your area, this could lower your healthcare costs. This means you wouldn’t need a separate Medicare Part D plan. A secondary payer could help cover this cost.Īdditionally, most secondary payer insurance offers coverage for prescriptions. If your stay is longer than 60 days, though, there is a $371 coinsurance cost per day.
Medicare Part A will be your primary payer in this case. Secondary payers are also useful if you have a long hospital or nursing facility stay. However, even with this added cost, many people find their overall costs are lower, since their out-of-pocket costs are covered by the secondary payer. In 2021, the standard premium is $148.50. You’ll pay this amount in addition to the standard Part B premium. Secondary payer plans often come with their own monthly premium. This can include dental visits, eye exams, fitness programs, and more. If you have a health plan from your employer, you might have benefits not offered by Medicare. This means that unless you’re receiving a service that isn’t covered by Medicare, the bill will go to Medicare first.Ī secondary payer can help you get even more coverage than offered by Medicare. Is Medicare primary or secondary?įor many Medicare beneficiaries, Medicare is always the primary payer. When this happens, you’ll receive a bill for the amount left after the primary and secondary payer’s coverage. In some cases, the secondary payer might not pay all the remaining cost. If you have a secondary payer, they’d pay the $20 instead. Normally, you’d be responsible for the remaining $20. If your primary payer was Medicare, Medicare Part B would pay 80 percent of the cost and cover $80. The insurance that picks up the remaining cost is the secondary payer.įor example, if you had a X-ray bill of $100, the bill would first be sent to your primary payer, who would pay the amount agreed upon by your plan. The insurance that pays first is called the primary payer. When you use Medicare and another insurance plan together, each insurance covers part of the cost of your service. “World’s Most Ethical Companies” and “Ethisphere” names and marks are registered trademarks of Ethisphere LLC.Medicare can work with other insurance plans to cover your healthcare needs. BLUE CROSS ®, BLUE SHIELD ® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. are independent licensees of the Blue Cross and Blue Shield Association. CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc., CareFirst Advantage DSNP, Inc., CareFirst Community Partners, Inc., CareFirst BlueCross BlueShield Community Health Plan District of Columbia, CareFirst BlueChoice, Inc., First Care, Inc., and The Dental Network, Inc. of Maryland (used in VA by: First Care, Inc.). In Virginia, CareFirst MedPlus is the business name of First Care, Inc. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc. and Group Hospitalization and Medical Services, Inc. Serving Maryland, the District of Columbia, and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc.
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