Secondary health insurance

[leebee]

I am employed full-time and have pretty good health insurance through my job. However, when I turned 65 I had to sign up for Medicare. I only enrolled in whatever part it is that is required. My question is- when I filled out forms for a new doctor, they asked about primary health insurance and secondary. Should I list Medicare as the secondary insurance? Does it matter if I don't? I am not sure why I had to sign up for Medicare as I have my own medical insurance, but whatever. I just don't now if I should list Medicare as a secondary insurer, and why it would/wouldn't matter.

 

[HopperFan]

I am employed full-time and have pretty good health insurance through my job. However, when I turned 65 I had to sign up for Medicare. I only enrolled in whatever part it is that is required. My question is- when I filled out forms for a new doctor, they asked about primary health insurance and secondary. Should I list Medicare as the secondary insurance? Does it matter if I don't? I am not sure why I had to sign up for Medicare as I have my own medical insurance, but whatever. I just don't now if I should list Medicare as a secondary insurer, and why it would/wouldn't matter.

Is your company small, under 20 employees? My BIL had to sign up for Medicare because his company is small. DH did not have to sign up because his company is large. He won't go on until after he retires.

Sis is not happy about it because it reduced what their regular insurance would pay and now even with two insurances their out of pocket is higher plus having to pay for the Medicare. Def is more complicated now to determine all the angles.

 

[CynBeth]

I do medical billing. Because you are employed your health insurance from work is your primary insurance and Medicare is your secondary insurance as long as you have Part B and not just Part A which is only for hospital. If you have Part B it should cover anything your primary insurance did not. As an example I am just throwing this out without knowing your details but let’s say BC/BS is your primary ins and they paid and took their adjustment but left a pt responsibility of x amount due to deductible/copay/coinsurance. The claim then gets submitted to your secondary ins of M/C which would hopefully pay the remaining balance.

 

[leebee]

I do medical billing. Because you are employed your health insurance from work is your primary insurance and Medicare is your secondary insurance as long as you have Part B and not just Part A which is only for hospital. If you have Part B it should cover anything your primary insurance did not. As an example I am just throwing this out without knowing your details but let’s say BC/BS is your primary ins and they paid and took their adjustment but left a pt responsibility of x amount due to deductible/copay/coinsurance. The claim then gets submitted to your secondary ins of M/C which would hopefully pay the remaining balance.

Thank you, this is exactly what I was hoping to learn! I only have Part A, so no need to list it on the form for the doctor's office. I guess if I have to be hospitalized, maybe I should let the office know, but for general health care I'll just list my insurer (Cigna) until I retire. Thanks again!

 

[LuvOrlando]

This subject is such a thorn in my side, I hope it gets changed a lot.

From what I understand, only the Hospital coverage is compulsory to pay into no matter what BUT the Hospital coverage is secondary in use IF the business you are insured through has over 120 employees.

I just got a bunch of papers for Medicare with SSDI which startled me but after researching I realized I was able to opt out of everything except Hospital coverage because I can prove I am otherwise insured. If you opt out but do not have separate coverage there are a bunch of penalties which seem deeply unfair to me since the amount really isn't enough to live on if you happen to be alone and I can easily understand why people would prefer to not be homeless. This is a horrendous choice imposed on people IMO.

Still learning and but the seemingly VERY old fashioned mindset clawback provision of Medicare coming into focus seems punitive since it is forced on people whose companies have less that 120 employees and is called insurance but really acts like a loan. Regular insurance pays out and doesn't have a legal right to go back to the estate to be reimbursed, so it is not an appropriate term. Disturbing to consider how many families lost everything when their older family members ended up in the very expensive healthcare spiral from 2020. In particular, the clawbacks must have hurt minority groups who were 1) hit hardest and 2) might not have been able to understand the way it works. This sort of liability is absolutely invisible to young people but will destroy their families wealth & middle class inheritances so I think it should be dragged out into the light of day as a multigenerational issue, not just a elderly issue. Makes my blood boil to think that people who came to the US and worked hard all their lives for a home expecting to leave it to their kids could have it taken away.

Can't quite tell if they just keep a tab on all costs through life and clawback everything or some things or if it's random

The whole way this is set up is terrible IMO, it's possible I am misunderstanding parts of it because it is a very cumbersome read but thinking I am following it ok enough.

 

[barkley]

I just got a bunch of papers for Medicare with SSDI which startled me but after researching I realized I was able to opt out of everything except Hospital coverage because I can prove I am otherwise insured. If you opt out but do not have separate coverage there are a bunch of penalties

in the event, even decades down the line that you want or need to get the other portions of medicare-KEEP proof for every year from now on of your coverage from other sources. you will be asked to provide it and failing to do so-will get hit with the penalties. i am an admitted pack rat and one of the times it came in handy was a few years back when dh and i decided to dump my former employer's outrageously overpriced retiree health plan and just go with a medicare advantage plan. i initially thought i could get proof from the insurance company that had covered us for decades (dating back to when i was an active employee)-no such luck. i was told (a) they didn't keep records for more than a handful of years, and (b) b/c the names of the plans had changed over the years/they had internally restructured their company multiple times-it would be impossible to figure out what i was covered under/when. thankfully i had kept the yearly notices my retirement board sent that detailed out our coverage each year.

 

[tazdev3225]

I do medical billing. Because you are employed your health insurance from work is your primary insurance and Medicare is your secondary insurance as long as you have Part B and not just Part A which is only for hospital. If you have Part B it should cover anything your primary insurance did not. As an example I am just throwing this out without knowing your details but let’s say BC/BS is your primary ins and they paid and took their adjustment but left a pt responsibility of x amount due to deductible/copay/coinsurance. The claim then gets submitted to your secondary ins of M/C which would hopefully pay the remaining balance.

I had the opposite experience. My husband had 2 strokes while still working and was forced to retire. We got Social Security right away. A few months later he was on Medicare but we still had his coverage from work for an additional 5 years. Medicare became his primary insurance and Blue Cross with the city was the secondary insurance. When I turned 65 last year I went on Medicare as advised by our finance guy. The same thing happened, Medicare is primary. Several people I know had the same thing happen while still working.

What I found out this year is that the medigap insurance we needed since we lost the coverage from work was easy to get for both if us. The real issue was picking the right one because we will have it forever. You can change but after this we would have to submit to a medical questions. I won't have a problem but my husband will with all of his health issues. It really is no fun getting older.

 

[Pea-n-Me]

This is very confusing.

 

[CynBeth]

I had the opposite experience. My husband had 2 strokes while still working and was forced to retire. We got Social Security right away. A few months later he was on Medicare but we still had his coverage from work for an additional 5 years. Medicare became his primary insurance and Blue Cross with the city was the secondary insurance. When I turned 65 last year I went on Medicare as advised by our finance guy. The same thing happened, Medicare is primary. Several people I know had the same thing happen while still working.

What I found out this year is that the medigap insurance we needed since we lost the coverage from work was easy to get for both if us. The real issue was picking the right one because we will have it forever. You can change but after this we would have to submit to a medical questions. I won't have a problem but my husband will with all of his health issues. It really is no fun getting older.

There may be certain times like what was described by tazdev where it is different but in most cases it is as I described.

 

[LuvOrlando]

in the event, even decades down the line that you want or need to get the other portions of medicare-KEEP proof for every year from now on of your coverage from other sources. you will be asked to provide it and failing to do so-will get hit with the penalties. i am an admitted pack rat and one of the times it came in handy was a few years back when dh and i decided to dump my former employer's outrageously overpriced retiree health plan and just go with a medicare advantage plan. i initially thought i could get proof from the insurance company that had covered us for decades (dating back to when i was an active employee)-no such luck. i was told (a) they didn't keep records for more than a handful of years, and (b) b/c the names of the plans had changed over the years/they had internally restructured their company multiple times-it would be impossible to figure out what i was covered under/when. thankfully i had kept the yearly notices my retirement board sent that detailed out our coverage each year.

This is excellent advisement!

These days I think all this is now carefully recorded on Tax Returns because people are, I believe, fined in some way if they don't maintain coverage of some kind. Still, it's easy enough to just ask insurance to provide a proof of insurance printout or take a screenshot and send it to yourself in email from time to time. Maybe a random Explanation of Benefits for a bill once a year would be enough.

 

[lanejudy]

I had the opposite experience. My husband had 2 strokes while still working and was forced to retire. We got Social Security right away. A few months later he was on Medicare but we still had his coverage from work for an additional 5 years. Medicare became his primary insurance and Blue Cross with the city was the secondary insurance.

Your situation is different from the OP's because of the bolded statement. Once your husband retired, the insurance through his (former) employer is no longer primary. Medicare became his primary with the employer/retiree plan as secondary.

OP's situation is that she continues to be actively employed. That is the key term: actively employed. As long as the employer insurance is through active employment it is primary with Medicare secondary.

@leebee -- we have a similar situation, DH is covered by my family plan which is through my employer; his Medicare is secondary. You can list the Medicare with your doctor, just be sure to note that it's Part A only and secondary coverage. Some procedures may be covered under Part A even if not hospitalized. But again with your situation it would be secondary and all claims must go through the primary insurance first (Medicare will actually deny it if submitted to Medicare first).

 

[lanejudy]

If you have Part B it should cover anything your primary insurance did not. As an example I am just throwing this out without knowing your details but let’s say BC/BS is your primary ins and they paid and took their adjustment but left a pt responsibility of x amount due to deductible/copay/coinsurance. The claim then gets submitted to your secondary ins of M/C which would hopefully pay the remaining balance.

This is NOT necessarily true. When Medicare is secondary, it does not necessarily cover deductible/copay/coinsurance as determined by the primary coverage. In our experience, a Medicare Advantage plan is more likely to cover those while Original Medicare (Part B) usually will not. I believe there are some Medigap or Supplemental policies that will actually pay the remaining balance, but not necessarily Medicare Part B coverage.

 

[tvguy]

There are non-profit Medicare counseling services not affiliated with any insurance company that can help you make sure you have the right coverage. This is a free service. They would have the information you need to figure out exactly what coverage you need and how it meshes with your employer coverage.