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

Medicare Publication #02179 or their website, will tell you just about everything you need to know.  See also our page on dual coverage in general.

Medicare - Who pays first - Publication 02179
Medicare – Who pays first – Publication 02179
Coordination of benefits – two or more insurance plans


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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


(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.


Related Pages Dental » Coverage for Dental Accidents under Medicare? »

Dual Coverage in General

40.3 – Other Coverage

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