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Why did I receive an Explanation of Benefits from my secondary insurance and nothing from Medicare?
Sometimes Medicare is able to send your claim directly to your secondary insurer based on eligibility information. Medicare payments are based on when the claim is received by Medicare rather than the date you received service. You may also receive a response from your secondary insurance before you receive a Medicare Summary Notice (MSN) because MSNs are sent out once all claims within a 30-day period are processed by the Medicare contractor.
I don’t have any other type of insurance in addition to Medicare. Why do I keep getting notices asking whether or not Medicare is my primary insurance plan?
Medicare does not automatically know if you have other insurance coverage. Medicare sends you an Initial Enrollment Questionnaire about three months before you are eligible for Medicare. This questionnaire will ask you if you have and plan to keep your group health insurance through your work or that of a family member. Your answers to this questionnaire are used to help Medicare set up your file, and make sure that your claims are paid by the right insurance.
Will my secondary insurance cover my deductible and/or 20% coinsurance?
It depends on the type of secondary insurance that you have purchased. Some plans may cover the Medicare deductible and coinsurance amount while others may not. You should contact your supplemental insurer to confirm if your plan helps pay for these expenses.
I have more than one insurance. How do I know who pays first?
If any of the following situations apply to you, your other insurance may be primary to Medicare, meaning the other insurance pays first:
You have Medicare; are still working; and are covered by your employer’s health insurance plan;
You have Medicare, are retired, but your spouse is working and has a health plan that also covers you; or
You are injured on the job, in an automobile accident, or slip and fall at a shopping center (worker’s compensation, auto insurance or liability insurance may cover the cost of medical care related to the accident).
You can contact the Coordination of Benefits Contractor at 1-800-999-1118 for questions about, or to report changes in, your primary insurance.
If you have other insurance and it pays after Medicare, it is called your supplemental insurance. Supplemental insurance often covers the deductible and/or co-payments required by Medicare. Examples include:
Retiree insurance from your former employer or union;
Medigap insurance;
Tricare for Life (for military retirees); and
Medicaid.
Should I notify Medicare when my spouse and I are no longer working?
Yes. It is important that you contact Medicare when you or your spouse are no longer working or other information has changed. If you or your spouse has recently retired, you should contact the Coordination of Benefits Contractor at 1-800-999-1118.
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