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Can Medicare Insurance be secondary?

Updated: Aug 18, 2023

Medicare is a federal health insurance program that provides coverage to individuals who are 65 years of age or older, as well as to people with certain disabilities and medical conditions. While Medicare offers comprehensive coverage for many medical expenses, it is often the case that Medicare is not the only insurance that a person has. In fact, many people have Medicare as their secondary insurance, meaning that they have another primary insurance plan that covers some of their medical expenses. In this blog post, we will explore what it means for Medicare to be a secondary insurance plan, how it works, and what you need to know if you have Medicare as your secondary insurance.


First, let's start by defining what it means for Medicare to be a secondary insurance plan. When Medicare is secondary, it means that another insurance plan, such as an employer-sponsored health plan, is responsible for paying for the majority of a person's medical expenses. Medicare would then only pay for costs that the primary insurance plan does not cover, such as deductibles, copays, and coinsurance.


The reason that a person may have Medicare as their secondary insurance is because they are still working and have coverage through an employer-sponsored health plan. In this case, the employer-sponsored plan is considered the primary insurance plan, and Medicare is secondary. This means that the employer-sponsored plan pays first for medical expenses, and Medicare only pays for what the primary plan does not cover.


It is important to note that the coordination of benefits between Medicare and the primary insurance plan is crucial. This is because Medicare must follow specific rules to ensure that it only pays for the medical expenses that it is responsible for. For example, if a person has a primary insurance plan that covers prescription drugs, and they also have Medicare Part D (which covers prescription drugs), then the primary plan would pay first, and Medicare Part D would only pay for the costs that the primary plan does not cover.


If you have Medicare as your secondary insurance, there are a few things that you should keep in mind. First, you should always provide both insurance cards to your healthcare provider to ensure that they know how to properly bill your medical expenses. You should also keep track of what expenses are covered by each insurance plan, and make sure to pay any out-of-pocket costs that are not covered by either plan.


In conclusion, Medicare can serve as a valuable secondary insurance plan for individuals who have coverage through an employer-sponsored health plan. However, it is important to understand how Medicare works as a secondary plan, including its coordination of benefits rules, in order to ensure that you are getting the most out of your insurance coverage. By staying informed and organized, you can navigate the complexities of Medicare and get the healthcare coverage that you need.

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