Medicare as Secondary

[lanejudy]

I know there are others who have dealt with Medicare as secondary payer. Just curious if you've had a Medicare representative say "Medicare doesn't cover deductible [assigned by the primary coverage]." We've dealt with the dual coverage for several years but suddenly this year we're getting the runaround with Medicare "approving" a claim but refusing to pay if it falls under the primary insurance deductible. In the past it always reduced (not eliminated) our out-of-pocket -- whether that be assigned by the primary as deductible or copay or coinsurance. This year seems to be functioning differently and I'm curious if others have similar issues or maybe if I just lucked out in the past.

 

[_19disnA]

Every insurance company has their own rules about what they do/don't cover, deductibles/etc. Hard to compare with someone else who might have different coverages. From one year to the next, your insurance provider may also make adjustments in what gets paid as medical costs continue to go up. If you reach 65 and are still working full-time, need to signup for Medicare, but the coverage provided by your employer would also be a factor.

 

[lanejudy]

I am well-versed in the intricacies of various medical coverages and aware that can vary even with the same insurance company. My basic question is whether anyone else has been told a blanket statement: "Medicare doesn't cover deductible” as secondary payer.

 

[starry_solo]

Do you have straight Medicare, as in directly through them, versus through an insurance company / Senior Advantage plan?

I just know that the parents are treated differently than standard Medicare patients because they have a Senior Advantage plan through a HMO.

 

[Alexle2007]

I am well-versed in the intricacies of various medical coverages and aware that can vary even with the same insurance company. My basic question is whether anyone else has been told a blanket statement: "Medicare doesn't cover deductible” as secondary payer.

I would suggest you recontact CMS if you think you were given incorrect information on their program. Additionally, they have a live chat option. You could also do a search on their website to see if they have an answer. Here’s some information I found:
https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance