How are claims paid if you have Medicare & Other Insurance?

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Medicare Publication #02179 or the Medicare website, will tell you just about everything you need to know on having two or more policies covering the same thing, at the same time.  

See also our page on dual coverage in general.

To get immediate quotes, information and enroll ONLINE, click here for Blue Cross and here for Blue Shield

 

Dual Coverage Questions from a website visitor 
Answered in Interlineation

My wife (I have full authorization filed for disclosure) is 69 and coverage by traditional Medicare (A and B) and also has group health insurance under a group of less than 20 employees.

***Thus Medicare pays first.

She had an accident and fractured her teeth requiring implant and new porcelain/ceramic pontics.

***Thus Medicare would pay for an accident, but not routine dental.

Claims were submitted to BCBS of Florida who says we should have first submitted the claim to Medicare.

***That’s correct, as Medicare pays first, then your group plan picks up the rest.

I have already paid directly for the services.

We reside in Florida and there were two D.M.D.’s (Doctor of Dental Medicine – same as DDS) involved in providing the services.

What do you recommend?

***I suggest that you just send the bill to Medicare.  Then resend to your group plan, once Medicare has paid.

If you want to double check, try calling the:

Benefits Coordination & Recovery Center (BCRC)—The company that acts on behalf of Medicare to collect and manage information on other types of insurance or coverage that a person with Medicare may have, and determine whether the coverage pays before or after Medicare. This company also acts on behalf of Medicare to obtain repayment when Medicare makes a conditional payment, and the other payer is determined to be primary

1-855-798-2627.

(Also, when we look at my wife’s profile online

***Do you mean her Medicare profile? www.MyMedicare.Gov?

it doesn’t list the supplemental carrier at all. How to we correct that?

***Send me your password privately and I’ll figure it out.  Medicare also has a customer service and live chat on the website.  They should be able to help you.

Graphic of when you can enroll based on turning age 65
Graphic of when you can enroll based on turning age 65  *  Publication 11036  *

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.

Example

For example, if you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

If you have to buy Part A and/or Part B, you can only sign up during a valid enrollment period.

Note

If you wait until the month you turn 65 (or the 3 months after you turn 65) to enroll, your Part B coverage will be delayed. This could cause a gap in your coverage.

In most cases, if you don’t sign up for Medicare Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll have to pay this penalty for as long as you have Part B and could have a gap in your health coverage.

Find out when you’re eligible for Medicare.

The best time to sign up is 3 months before your 65th birthday and coverage will start on the 1st of the month of your birthday.   Be sure to let your prior carrier know at least 30 days in advance.  Especially if it's Covered CA!  That way you don't have double premiums and duplicate coverage.

Once you enroll in Parts A & B, you are then eligible to get a Medi Gap Plan and part D Rx or Medicare Advantage (HMO) to fill in the gaps that Medicare doesn't pay.  Please note that prescription drug coverage is mandatory with a penalty when you eventually sign up, if you didn't  sign up when you are supposed to.

Coordination of benefits – two or more insurance plans  

 

Medicare and You 2019 - Everything you want to knowMedicare and You 2019 #10050 - Everything you want to know * See their section on closing the donut hole

medicare.enrollmentPublication 11036 28 Pages

3 comments on “Medicare – Dual Coverage

  1. I’m turning 65 and I have an individual plan that doesn’t have a co-ordination of benefits clause along with a Covered CA plan. I’ve been able to collect twice as the individual plan doesn’t have a co-ordination of benefits clause.

    I’m turning 65, it appears that my individual plan, won’t duplicate benefits with Medicare.

    Does that mean I can’t collect twice? Can I collect up to 100%?

    Medicare Duplicate

    • Coordination of benefits (COB) allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities (i.e., determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan).

      Ensures that the amount paid by plans in dual coverage situations does not exceed 100% of the total claim, to avoid duplicate payments. CMS.gov

      noun: duplicate; plural noun: duplicates
      /ˈd(y)o͞opləkət/Submit
      1.
      one of two or more identical things.
      “books may be disposed of if they are duplicates” Google

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