When you turn 65 and enroll in Medicare and a Medicare Insurance plan you may wonder how your bills are covered. The basic way to explain this is there is a primary and secondary payer. Sounds simple, and it really is, but there is more explaining to do.
Who is the Primary Payer?
The primary payer is the insurance that pays first. This can be confusing because technically they pay first it doesn’t mean their payment is received first. Here is how it works: your primary payer pays up to the limits of its coverage for your service, the left over may or not be covered by the secondary payer.
Who is Secondary Payer?
The secondary payer is the insurance company that pays second. Much to many people’s surprise the secondary payer may be Medicare -this situation generally occurs when you have employer insurance past 65. Usually the secondary payer is your Medicare Insurance plan, like Medigap.
An example of a primary and secondary payer is: If you visit your Medicare-approved doctor, Medicare Part B will pay 80% of the cost which leaves 20%. Most Medigap plans will pay the entirety of the 20%.
Does the Secondary Payer Pay All Costs?
Not always. Sometimes you may have Part B excess charges that leave a little extra. Here’s a situation in which you may be responsible for excess charges: if your doctor doesn’t accept Medicare assignment but allows you to visit them they are ONLY allowed to charge 15% more than Medicare allows for. This 15% is the excess and only Medigap F, High-F, and G cover the Part B excess charge. So if you prefer a doctor that doesn’t take assignment you may want to choose one of these plans.
To get a Medigap quote click on the button below. If you have any questions about Medicare or Medicare Insurance call the number above or contact Senior65.com.