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What Does Medicare Pay as the Secondary Payer


Guest wekiva

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Guest wekiva

I have an employee whose wife is on SSI. She has Medicare Part A and is covered on our GHP. In our situation, Medicare is the secondary payer. She does not have Medicare Part B, but is considering enrolling. The employee has asked for some information on coordination of benefits if she enrolls in Part B.

I searched the Medicare site and read the Medicare & You book and the Medicare Who Pays First guide. From what I understand, Medicare will coordinate its payments with an employer's group insurance and, when the GHP is the primary payer but does not pay in full for the services, Medicare becomes the secondary payer and pays for Medicare-covered service up to the Medicare approved amount. Ideally, the result of this coordination is that medical bills are paid in full.

What I haven't been able to find is specific information on when and how Medicare pays. For example, when do the Medicare benefits kick in? Does the employee have to first meet the GHP deductible and begin paying the coinsurance before Medicare pays? Is the Medicare deductible counted with the GHP deductible or will the spouse need to first meet the GHP deductible and then the Medicare deductible? If the employee's GHP coinsurance is 25%, does Medicare pay 80% of that 25%, or would the 80% cover the entire 25%?

Thank you for reading my post. Any information will be appreciated.

wekiva

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  • 2 weeks later...

Hello

I have attached a document that may be helpful. My only comment or recommendation is that you change your plan so that at age 65, Medicare becomes primary and not your own plan.

The attached is for a company plan that Medicare is primary and the company plan is secondard.

2007_OE_Guide_Heritage_CTR_Salary_Retirees_Medicare_Calculation.txt

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