FAQs
Live chat with us, and find local organizations that can help answer your Medicare questions. You can also: Call us at 1-800-MEDICARE (1-800-633-4227). Help from Medicare is available 24 hours a day, 7 days a week, except some federal holidays.
What is the difference between primary and secondary Medicare? ›
The primary payer pays up to the limits of its coverage. The secondary payer only pays if there are costs the first payer didn't cover. The secondary payer (which could be Medicare) might not pay all of the uncovered cost.
Will Medicare pay as secondary if primary denies? ›
The group health plan pays first, and Medicare pays second.
If the group health plan didn't pay your entire bill, your provider should send the bill to Medicare for secondary payment. You may have to pay any costs Medicare or the group health plan doesn't cover.
What is a Medicare secondary payer questionnaire? ›
CMS developed tools, including an MSP model questionnaire, Admissions Questions to Ask Medicare Beneficiaries, to help providers identify the correct primary claims payers for all beneficiary-furnished services in a hospital.
What questions are asked in a Medicare exam? ›
At your Medicare annual wellness visit, your health care provider will: Review your blood pressure, heart rate, height, weight and body mass index (BMI). Review your current health problems, as well as your medical, surgical, family and social histories. Review your current medications.
What are the 6 things Medicare doesn't cover? ›
Some of the items and services Medicare doesn't cover include:
- Eye exams (for prescription eyeglasses)
- Long-term care.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary payer. The secondary payer only pays if there are costs the primary insurer didn't cover.
Is it worth having primary and secondary health insurance? ›
Multiple health plans can help reduce out-of-pocket costs, especially if you expect to need healthcare in the coming year. For instance, if you're expanding your family or expect to need costly surgery in the coming year, a secondary health plan can help offset those out-of-pocket costs.
What is the best secondary insurance to Medicare? ›
Our Top Medicare Supplement (Medigap) Plans
- Best Additional Plan Benefits: Humana.
- Best Membership-Based Perks: AARP by UnitedHealthcare.
- Best Plan Variety: Blue Cross Blue Shield.
- Best Rewards Program: Cigna.
- Best Financial Reputation: State Farm.
If the disabled person still has insurance from an employer or from a working spouse's employer, Medicare is secondary if the employer has at least 100 employees, but primary if it has fewer.
Medicare will normally act as a primary payer and cover most of your costs once you're enrolled in benefits. Your other health insurance plan will then act as a secondary payer and cover any remaining costs, such as coinsurance or copayments.
What happens if secondary insurance pays more than primary? ›
A credit balance results when the secondary payer allows and pays a higher amount than the primary insurance carrier. This credit balance is not actually an overpayment. The amount contractually adjusted off from the primary insurance carrier was more than needed, based on the secondary insurance carrier's payment.
How do you bill Medicare when it is a secondary payer? ›
When Medicare is the secondary payer, submit the claim first to the primary insurer. The primary insurer must process the claim in accordance with the coverage provisions of its contract.
Does Medicare Secondary cover primary deductible? ›
Having Medicare as secondary insurance may not cover some primary deductibles when the primary insurance plan excludes them from coverage. For example, if your primary insurance plan does not cover elective procedures or alternative therapies, Medicare as secondary insurance may also exclude these costs.
What are some scenarios where Medicare can be a secondary payer? ›
Medicare may be the secondary payer when a person: has a GHP through their own or a spouse's employment, and the employer has more than 20 employees. has a disability and is covered by a GHP through an employer with more than 100 employees.
How to solve problems with Medicare? ›
Contact the MBO. If you have been unable to resolve your concern with your plan or 1-800-Medicare, ask a 1-800-MEDICARE representative to submit your complaint or inquiry to the MBO. The MBO will help to ensure that your inquiry is resolved appropriately.
How can I get explanation of benefits from Medicare? ›
Your plan will mail you an EOB each month you fill a prescription, visit a health care provider, or file a claim. This notice gives you a summary of your claims and costs. For more up-to-date claims information, contact your plan.
How do I access Medicare statements? ›
Medicare's Medicare.gov website allows beneficiaries in Original Medicare to log into (or create) a secure Medicare account to view their most recent MSNs, track claims made on their behalf, and check payment status.
Which people qualify for Medicare benefits responses? ›
Medicare Part A (hospital insurance)
People age 65 or older, who are citizens or permanent residents of the United States, are eligible for Medicare Part A.
