Community Chat

[muttmom]

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@lucieinthesky wrote:

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@muttmom wrote:

Why isn't Medicare your primary and your husband's insurance secondary?

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That I really don't know. I would suppose it is because I had husband's insurance before becoming eligible for Medicare. Are you telling me Medicare should be my primary?

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I have insurance through my former employer and my husband's is my secondary.  I will soon be 65 and was told Medicare will be my primary and my insurance will be my secondary.  My husband's will drop off.

[KathyPet]

If you are enrolled in Medicare it is always primary.  Your coverage with your husband's employer becomes secondary and will only pay the portion that Medicare did not cover.

[Carmie]

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@KathyPet wrote:

If you are enrolled in Medicare it is always primary.  Your coverage with your husband's employer becomes secondary and will only pay the portion that Medicare did not cover.

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That is not a true statement.  If you or your spouse are still working and eligible for Medicare and the employer has 20 or more employees, the primary insurance is the employees group plan and Medicare is secondary.

You can look up this information under TEFRA.

It is also possible that Medicare will not pick up a balance left after the primary plan.  There are many things that are not covered by Medicare, but could be covered under the group plan.

[Carmie]

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@MKR14 wrote:

An organized office staff are required to see your Medicare card-especially before surgery- to verify you still have the insurance and it is the same ID number. If your spouse has passed away tou will have a new card and ID and different letter at the end. A Retired Railroad Employees Medicare card has a different address than regular Medicare for submitting claims also. It is for your protection to have them verify it as sometimes you may only have Part A and not Part B as well. Part B coverage is for office calls and Part A coverage is for hospital. Some patients only had one of the coverages. Also there may be that your yearly deductible hasn't been met for the year if you are a healthy person and don't see a doctor very much. It sounds like they were doing a good job and will get to the bottom of what is going on for your benefit as well as address your problem. IIt is frustrating as we all deal with this every now and then. I enjoyed my job and would have asked to see and copy your card once a year also.

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Your Medicare number does not change after your spouse dies in every case.

If you collect SS Unser your own work records, your Medicare number will be your SS number with an A after it.  If you collect under your living spouse, your number will have a B after it.  IF you collect on your deceased spouse' work record, you will have a D after your number.

If you collect under your own work history, you will always have an A after your number, even if your spouse dies.

[on the bay]

@lucieinthesky~

I know this can all get so time consuming and we are "supposed to know things"

If I get a bill (I have medicare and other insurance), I always make sure they have submitted the claim properly and so many times they have not!

I think you always have a right to do this before you pay any money!

And when you have 2 insurances, you should not have to pay $ "up front!" It is their responsibility to file the claim unless they are some kind of private practice that doesn't always take insurance like alternative, etc.

I did not  know Medicare would become primary either when I first got it and many providers billing offices didn't know either because they would mix it up. But my understanding is that it does become primary, but to make sure , you can call your medicare office.

I agree with everyone who said go to the office directly with your papers and then there is no reason they should not issue you a credit (or check) right there and then! If not, thats when I would tell them I would be filing reports and calling attorney general, state insurance commissioner etc.

But like someone else said, this involves lots more of your time and effort and you are not getting paid to fix their mistakes. But if you still want to and it makes you feel better, go ahead and file a complaint against them!

This is so disheartening and it happens to so many of us who are more than tired of it! Plus the last thing you need when you are sick or surgery or whatever is to have to spend hours trying to fix their mistakes!

And it should NOT be all so confusing!  

[itiswhatitis]

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@Carmie wrote:

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@KathyPet wrote:

If you are enrolled in Medicare it is always primary.  Your coverage with your husband's employer becomes secondary and will only pay the portion that Medicare did not cover.

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That is not a true statement.  If you or your spouse are still working and eligible for Medicare and the employer has 20 or more employees, the primary insurance is the employees group plan and Medicare is secondary.

You can look up this information under TEFRA.

It is also possible that Medicare will not pick up a balance left after the primary plan.  There are many things that are not covered by Medicare, but could be covered under the group plan.

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Yes, when I had two coverage amounts it was called "coordination of benefits" and the primary payee was determined by something called the "birthday rule."  In that case, my spouse's insurance was first, then mine.

[itiswhatitis]

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@KathyPet wrote:

If you are enrolled in Medicare it is always primary.  Your coverage with your husband's employer becomes secondary and will only pay the portion that Medicare did not cover.

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https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/how-medi...

Get further information and facts on how this all works here.

[Moonchilde]

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@muttmom wrote:

Why isn't Medicare your primary and your husband's insurance secondary?

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If someone is eligible for Medicare but is still working and has had insurance through their employer all along, they must sign up for Part A when they turn 65 but they don't have to sign up for Part B until they actually stop working. The insurance through work is primary in this situation and Medicare secondary. I assume it would work the same for a dependent (wife).

I had Part A and was working when I had my cataract surgeries. Since Part A is hospitalization only and I was not hospitalized, Medicare was not involvec - BS paid for my surgeries.

[lucieinthesky]

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@Moonchilde wrote:

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@muttmom wrote:

Why isn't Medicare your primary and your husband's insurance secondary?

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If someone is eligible for Medicare but is still working and has had insurance through their employer all along, they must sign up for Part A when they turn 65 but they don't have to sign up for Part B until they actually stop working. The insurance through work is primary in this situation and Medicare secondary. I assume it would work the same for a dependent (wife).

I had Part A and was working when I had my cataract surgeries. Since Part A is hospitalization only and I was not hospitalized, Medicare was not involvec - BS paid for my surgeries.

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Thank you for that clarification. That is my situation. My husband is still working, so we have insurance through his employer. When we both reached 65, we signed up for Medicare Part A. Six months later, I decided to go ahead and get the Part B added. So, until my husband retires (which is coming up next year), his insurance is my primary. After he retires, he will still be covered, but I will be dropped. So, then, medicare will become my primary and I will probably have to look around for a supplemental policy.  

[Mominohio]

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@KathyPet wrote:

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@MyGirlsMom wrote:

Stop calling.

Go to the office wit your EOB's from Medicare and speak to someone directly in the claims department.

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ITA.  Stop calling!  Take the form you received fromMedicare showing that they paid and go into their office and insist on speaking to the person who,handles the billings.

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And I'll add to both these good pieces of advice, to just be calm and know that today there is so much incompetence and lack of timeliness in getting things resolved. 

It isn't unusual to have to make contact numerous times, show your documentation, and wait. 

Just don't give up, be firm but polite, and work your way up the chain of command at the dr.'s office first, before going anywhere else. 

But I totally agree about going directly into the office. It's harder for them to put you on a shelf when you're standing right there.