Secondary insurance is not the same as supplemental insurance. A secondary insurer could be Medicaid, your employer’s health coverage or your spouse’s workplace coverage, for instance. Supplemental insurance, also called Medigap, is specifically tailored to cover copayments, coinsurance, and deductibles that Medicare doesn’t pay, and possibly services Medicare doesn’t reimburse. Medigap is designed not to cover the same expenses as Medicare.
Medicare as a Secondary Insurance Customer
Often policies have a tendency to overlap or duplicate each other. Take young person’s Medicare health care plans for instance: often these can reduce the amount paid out by a percentage via a ‘reduction in benefits’ clause, particularly if they are protected under their parent or guardian’s plan. Should this be the case, a secondary insurance policy will pay the balance that is not paid by the primary insurance policy.
Medicare can be primary or secondary to employer insurance
It is very important that you talk to your benefits manager at your job when you become eligible for Medicare, as your employer insurance will work differently with Medicare. Sometimes companies do not realize that you are eligible for Medicare and they may continue to pay primary when they should not be. When the company realizes they may be able to take back money they paid for your medical services while you should have had Medicare and you may be left very large bills.
Will my secondary insurance pay for my Medicare deductible and/or 20 percent coinsurance?
Beneficiaries enrolled in Original Medicare may choose to enroll in a Medicare Supplement plan to fill in the gaps in coverage and cover some of the costs of care not covered through Original Medicare. Some Medicare Supplement plans cover the out-of-pocket costs associated with Original Medicare, such as deductibles and coinsurance payments. Therefore, some Medicare Supplement plans may pay for your deductible and/or your coinsurance and/or other out-of-pocket costs not covered by Original Medicare. Contact your Medigap plan directly to see if it covers these costs.
How Medicare works with other insurance
A conditional payment is a payment Medicare makes for services another payer may be responsible for. Medicare makes this conditional payment so you won’t have to use your own money to pay the bill. The payment is “conditional” because it must be repaid to Medicare if you get a settlement, judgment, award, or other payment later. You’re responsible for making sure Medicare gets repaid from the settlement, judgment, award, or other payment.
How Does Secondary Health Insurance Work?
A standalone accidental policy is generally a secondary health insurance policy. This type of supplemental insurance pays if the policyholder is involved in an accident. The policy may have limitations based on what coverage the primary policy provides or may pay specific amounts for specific services. For example, suppose a visit to the emergency room costs the policyholder $10,000 in total charges. The primary health insurance plan then agrees to pay $8,000 of the cost. The accidental policy, the secondary insurance in this example, would then be billed for the remainder.