When Can Medicare Be A Second Contributor?

When Can Medicare Be A Second Contributor?

Payments from Medicare typically work perfectly. Generally, you pay a co insurance or co payment and do not have to worry about submitting a Medicare claim. If you have other health insurance apart from Medicare, Medicare could be a secondary contributor. Let’s see how that works.

What does being a secondary contributor mean?

If Medicare (or a Medicare insurance option, such as a Medicare Advantage policy) is not your only health insurance, Medicare and your other insurance company will decide on the coordination of benefits to determine who will pay first.  The principal contributor (i.e. the one who pays first) pays first his share of the medical expenses reimbursed. Then, the secondary contributor pays its own share of what the primary contributor has not paid. Sometimes there is also a third contributor. You may have to pay the balance of what insurers, including Medicare, have not paid.

When can Medicare pose as a secondary contributor?

When you have signed up to Medicare, Medicare will then coordinate benefits with other insurance you may have. Whether Medicare is the second or the main contributor will depend on your situation. Below are some situations when Medicare could be a secondary contributor:

You are insured by an employer group policy, for you or your spouse, and the employer has a minimum of 20 employees. Medicare is usually the secondary contributor. You are below 65 and is retired, and have a disability that is not ESRD. Perhaps your spouse is still working and you are insured with your spouse’s group policy. Your spouse’s employer has at least 20 employees or a group policy for multiple employers.

You are qualified for Medicare due to an end-stage renal disease (ESRD) and are insured by a group policy. There is a coordination time of approximately 30 months after you qualify for Medicare when Medicare is the second contributor. Get a Blue Cross Blue Shield Advantage plan at https://www.medicareadvantage2019.org/bcbs-medicare-advantage-plans-for-2019

When is Medicare the main contributor?

You are below 65 years and are retired, and you have a disability that is ESRD. Perhaps you are insured by your former employer’s health insurance.  If you still work and your employer employs less than 100 people, Medicare usually pays first. Medicare can however be the second contributor if your employer participates in group insurance for multiple employers. If you are still working and your employer has less than 20 employees, Medicare usually pays first. However, Medicare can be the second contributor if your employer participates in group insurance for multiple employers.

You are eligible for Medicare because you have end-stage renal disease and are insured by a group policy. After a coordination period of approximately 30 months, this Medicare is usually the main contributor.  Is Medicare the secondary contributor? That depends on your insurance.  Keep in mind that there are many different situations in which you have other insurance besides Medicare. The examples listed above are just some examples.  If you have any questions or wish to report changes to your health insurance policy, contact the Medicare Coordination and Recovery Benefits Center between 8:00 a.m. and 12:00 p.m. at 1-855-798- 2627 (TTY: 1-855-797-2627) Monday through Friday at 8:00 PM EST.