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

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.

Medicare Secondary Payer Recovery Process  
Click to Enlarge 

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.

Coordination of Benefits & Recovery Overview

Beneficiary Services  

Contact Page  

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.

(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.

Subrogation

Notice about Medicare secondary payer subrogation rights

We have the right and responsibility to collect for covered Medicare services for which Medicare is not the primary payer. According to CMS regulations at 42 CFR sections 422.108 and 423.462,    Anthem MediBlue Access (PPO), as a Medicare Advantage organization, will exercise the same rights of recovery  that the Secretary exercises under CMS regulations in subparts B through D of part 411 of 42 CFR and the rules established in this section supersede any state laws.  Anthem MediBlue Access (PPO) Evidence of Coverage

Medicare & other types of health coverage 
Medicare & Medicaid 
Medicare & group health plan coverage
Medicare & group health plan coverage after you retire
Medicare & group health plan coverage for people who are disabled (non-ESRD disability)
Medicare & group health plan coverage for people with End-Stage Renal Disease (ESRD)
Medicare & no-fault or liability insurance
Medicare & workers’ compensation 
Medicare & Veterans’ benefits
Medicare & TRICARE
Medicare & the Federal Black Lung Benefits Program
Medicare & COBRA 

Coordination of benefits – two or more insurance plans  

 

Medicare and You 2020 #10050  
Everything you want to know 

Medicare and you

Different Parts of Medicare 

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx

Video

Understanding your Medicare Choices
Medi Gap vs Medicare Advantage

Topics

How to sign up for Parts A & B
Is  your test, service, or item covered?
Original Medicare Parts A & B
Medicare Advantage Plans & Part D Rx
Supplement Insurance (Medigap)
Low Income Help  LIS
Definitions

Enroll in Blue Cross

Enroll in Blue Shield 


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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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