Wellness

[I am still oxox]

My husband is currently working and his insurance is my primary and Medicare is my secondary.

My provider submits a bill to my primary insurance and they say I only have my normal $20 co pay, they then submit the same claim to Medicare and they pay my provider $17.00, so does this mean I owe my provider only $3.

I am new to Medicare and I am trying to find a bit of clarity, thanks all for the kind responses

[NicksmomESQ]

I’m not on Medicare but based on my understanding of primary & secondary insurance I believe you’re correct. You would only owe $3.

[Kachina624]

I believe Medicare pays an amount contracted for the service you got and the provider eats the difference.  That's why some doctors won't take Medicare.  Sometimes there's a huge difference between what the doctors charge and what they're paid,  but I've never been charged.

[lovesrecess]

Just make sure the person at the desk in the drs office knows you have Medicare. They must bill Medicare first; your insurance provider only pays after Medicare has paid their part. Medicare is considered your primary insurance, even if you have private insurance as well.

[proudlyfromNJ]

My provider knows exactly what Medicare Advantage plan pays for. She gives a number of different test in her office and has me get the ones I need every year. She sees me every three months to monitor my meds. I pay my co pay only when I see the Dr. never when I go for a test. 

When I get my statement from insurance company if there are any charges still owed, the Doctor has them removed from the bill. Been going for 6 years.

[I am still oxox]

@lovesrecess

Please read my post Medicare is secondary my husband is still working and works for the Gov't so it is an employer of more than 1,000, I have researched this thoroughly and need to explain it to every provider.

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@lovesrecess wrote:

Just make sure the person at the desk in the drs office knows you have Medicare. They must bill Medicare first; your insurance provider only pays after Medicare has paid their part. Medicare is considered your primary insurance, even if you have private insurance as well.

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[lovesrecess]

I did read your post. Not sure why you are offended. I got my info directly from Medicare and from Aetna, Blue Cross, and Humana. 

[I am still oxox]

@lovesrecess

I am not offended please bear in mind each situation is different, my primary is my husband insurance while he is still employed and Medicare is the secondary until he retires

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@lovesrecess wrote:

I did read your post. Not sure why you are offended. I got my info directly from Medicare and from Aetna, Blue Cross, and Humana. 

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[software]

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@lovesrecess wrote:

Just make sure the person at the desk in the drs office knows you have Medicare. They must bill Medicare first; your insurance provider only pays after Medicare has paid their part. Medicare is considered your primary insurance, even if you have private insurance as well.

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Not necessarily, those rules have changed.

The provider is sending the bill to her group insurance first, so that's not in question.

[Carmie]

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@lovesrecess wrote:

Just make sure the person at the desk in the drs office knows you have Medicare. They must bill Medicare first; your insurance provider only pays after Medicare has paid their part. Medicare is considered your primary insurance, even if you have private insurance as well.

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What you are stating is 100% incorrect.  Many people have Medicare insurance that is secondary.  You need to read about Medicare secondary payer laws.