@software wrote:
@Carmie wrote:
@fthunt wrote:
Don't even try to figure it all out - just when you 'think' you understand it all - they change the rules. Suggestion: IF you owe a balance they will bill you - believe me. They know where you live!
Actually, the rules have not changed. It has always been this way as far back as I can remember...the 1980's and it just as confusing to most people now as it was then.
Some people have primary insurance that pays everything at 100%, So there is no balance for Medicare to consider. I remember telling people to not even offer their Medicare card to the doctor's office to avoid confusion.
Sometimes the more insurance you have, the bigger your problems are.
I don't mean to belabor a point but there was a time when Medicare was always primary. I had an aunt who never worked, was on Medicare and her husband worked in the coal mines, with the coal miners union exceptional insurance. He was still employed at the time she was having serious medical events. Medicare was primary. I still remember her complaining about it. This was prior to 1980.
Even today, if Medicare won't cover a procedure, test, etc, your private insurance won't either, even if it would prior to you being on Medicare. I ran into this when I still worked but had to sign up for Medicare at age 65, before I retired. HR made this very clear to me & I confirmed with Medicare.
None of this answers the OPs question on co-pays - just saying.
I have worked in health insurance for over 25 years...since 1988 actually. Since I worked in Customer Service, I had to go to school to learn the laws for Federal Insurance, Medicare, private insurance and everything else you can think of and things you have no idea exist.
Medicare secondary laws as we know them have been on the books since 1980. Medicare only began in 1966. At that time, Medicare was secondary to workman's comp insurance only.
The MSP laws apply to people who have other insurance sometimes through an employer and it depends on the number of employees that employer has. Also, it depends if the employer Is self insured or not.
Many times and for most people Medicare is primary, but often it is not. The laws apply to the employee and their spouse.
Medicare is also still secondary to workman's comp and auto insurance as well, as in many accident cases, like when you fall in a store.
It is complicated and there is no one size fits all. Every person's circumstances are different.
Medicare wants to save money and will always find a way not to duplicate insurance coverage.
Also, private insurance pays for many things that Medicare does not. It always has. I am very confused by your statement that it doesn't. Private insurance does not have to follow Medicare guidelines for people who do not have Medicare.
If you have Medicare supplemental insurance, either privately or through an employer, it is 100% true that supplemental insurance will not pay if Medicare does not (except for a few services)
I did address the OP's original question.
Blogs & Forums
