I am still working and have health coverage. Will medicare supplement doctor visit co-pays if I have a PPO?
Total Comments: 21
Posted: Thu Apr 23, 2009 05:35 am Post Subject:
I am still working and have health coverage. Will medicare supplement doctor visit co-pays if I have a PPO?
I am assuming that you're 65 or older and are still enrolled in your group medical plan at work. The likely answer to your question is "no."
Medicare supplement policies are intended to plug the "gaps" in Medicare parts A & B, and are not intended to supplement your private insurance. There are 12 standardized Medicare Supplement plans, referred to as plans A through L. Plans K and L are "catastrophic plans" which have high deductibles. All insurers are required to sell plan A + one other of their choosing, and the plans offer different levels of benefits as you work your way through the "alphabet." There are 5 "core" benefits that must be included in all of the packages:
Part A Hospital Coinsurance for Days 61-90
Part A Hospital Lifetime Reserve Coinsurance for Days 91-150
365 Lifetime Hospital Days Beyond Medicare Coverage;
Parts A and B Three Pint Blood Deductible;
Part B 20% Coinsurance.
So, you see that these packages, if you're at all familiar with Medicare, are intended to supplement MEDICARE'S coverage, not your group health plan. Now, if you still have your group health plan, there could easily be overlapping coverage. In just about every situation in which there's group insurance and Medicare in place for a person, the group plan is the primary provider of coverage, with Medicare being secondary, or "excess" coverage. So, your claims would be submitted to your group carrier first and then to Medicare for their consideration. However, this is seriously tweaked by so many other things. Medicare has deductibles that must be met on both parts A & B of traditional Medicare. Will your co-pays exceed the deductibles? The hospital deductible (part A) for 2009 is $1,068 per occurrence (up $40 from 2008), and the part B deductible is $135 (same as last year).
I really don't see any need at this time to buy a MedSup policy. Your group plan and Medicare should be sufficient. In addition, if you want a MedSup policy, you'll have to be enrolled in both part A & B. You're now going to have to pay monthly premiums for part B coverage, which for most people is $96.40/month in 2009. If you make a lot of money, the premium's higher.
So...you could potentially be paying your group premiums, the medicare premiums, the MedSup premiums plus a host of other deductibles and whatnot for, ummm, you to save a $15 co-pay?
Hmmmmm.... I'm not sure that's such a great idea. :? But, to be perfectly fair, you should seek out the services of a competent professional ( I mean competent, not some "agent" who talks a good game). A good, GOOD place to discuss this is your states Senior Health insurance Assistance program, normally available through your state insurance commission. I have no idea what state you live in so I can't guide you.
I hope I helped, and if you need detailed info- go to my page in the Expert's Corner and leave me a pm with what you need.
InsTeacher 8)
Posted: Thu Apr 23, 2009 08:48 am Post Subject:
Yup, I would agree with Teacher. Medicare supplemental policies are to cover the gap in Medicare. It'd not support the private policy.
Medicare only pays a portion of the total medical cost of the enrollee, say 80%. The rest needs to be met by the recipient in terms of deductible and co-pay. Medical supplemental plan pays the gap left by the Medicare to minimize the senior's out-of-pocket expense. But unfortunately it'd not compensate for the non Medicare plan.
Hope it clarifies.
Thanks,
Rupert
Posted: Mon May 04, 2009 09:12 pm Post Subject:
I believe your question was will original Medicare help pay along with your private insurance (group coverage)? Your doctor will ask you which is your primary insurance and which is your secondary insurance. Most group policies differ, but you should check with your human resources department or your insurer to be exact.
Medicare pays 80% after their deductibles...and yes you can use it in conjunction with your group coverage.
BUT WHATEVER YOU DO>>>>
Do not sign up for a Medicare Advantage Plan (also called Medicare Part C) without knowing exactly what it would do to your group coverage. Even the application will tell you that it could negatively affect your group coverage.
Use your original Medicare and your group coverage, and if you retire and the group coverage is dropped (or you cannot afford increased premiums)...then and only then should you look at the Medicare Advantage plans. Even then, most of them don't cover that much...so be very careful. Medicare Supplements would be a good thing to consider at that point.
Let me know if you need any additional help.
Posted: Thu May 07, 2009 02:13 am Post Subject:
i wonder there would difference which one is our primary insurance and which one is the seconday insurance？ if medicare only pay 80percent after their deductibles. we should to pay that 20 percent personnaly or throw it to the secondary one? please clearify.
thanks and regards.
Posted: Thu May 07, 2009 09:32 am Post Subject:
You can either pay the deductible out-of-pocket or can have one of the several Medicare supplementary policies to cover the gap for you, if that's what you have meant by secondary policy.
Posted: Thu May 07, 2009 04:08 pm Post Subject:
When I worked for United Health Care the rule was that Medicare is ALWAYS the secondary insurance for an eligible senior citizen.
Even so, if you don't have Part B, regular doctor visits wouldn't be covered anyway... So the answer to your question is what teacher says...No. I also agree with him regarding getting a Med Sup policy... doesn't seem necessary.
Btw...The claims should be sent to Medicare even if Medicare isn't going to pay, because they may be applied towards your "deductible".
Posted: Fri May 08, 2009 05:16 am Post Subject:
When I worked for United Health Care the rule was that Medicare is ALWAYS the secondary insurance for an eligible senior citizen.
Does it mean that Medicare would play the secondary role to the existing coverage? How the primary and secondary coverage are determined?
Posted: Sat May 09, 2009 06:53 am Post Subject:
Kelvin,
Here's a good site that should help you with why Medicare is always secondary:
There are a lot of factors the Insurers use to determine primary/secondary coverage for anyone else... for example working spouses (where children are covered under both).
I could tell you that UHC used the spouses b-months among other things as criteria.
Posted: Thu May 27, 2010 04:35 am Post Subject: Medicare Part A
If my primary insurance covers 90% of hospitalization, will Medicare Part A cover the remaining 10% or nothing if they only cover up to 80%?
Posted: Tue Nov 30, 2010 05:35 am Post Subject: medicare vs grp hlth
duh..can't bee leave i'm such a dummy..m'care book says can sign up any time if have grp hlth thru work..my sweetie works & i'm undr 65 but disabled. 2day spoke to a m'care rep..told me co pays arn't covrd by m'care...depends..worked many yrs doing all kind of Cob w/m'care..lots of different ways..depending on policy wording..now i have to find out what 2 do..since i signed up quite a few years ago..& probably shouln't have...
Posted: Thu Apr 23, 2009 05:35 am Post Subject:
I am still working and have health coverage. Will medicare supplement doctor visit co-pays if I have a PPO?
I am assuming that you're 65 or older and are still enrolled in your group medical plan at work. The likely answer to your question is "no."
Medicare supplement policies are intended to plug the "gaps" in Medicare parts A & B, and are not intended to supplement your private insurance. There are 12 standardized Medicare Supplement plans, referred to as plans A through L. Plans K and L are "catastrophic plans" which have high deductibles. All insurers are required to sell plan A + one other of their choosing, and the plans offer different levels of benefits as you work your way through the "alphabet." There are 5 "core" benefits that must be included in all of the packages:
Part A Hospital Coinsurance for Days 61-90
Part A Hospital Lifetime Reserve Coinsurance for Days 91-150
365 Lifetime Hospital Days Beyond Medicare Coverage;
Parts A and B Three Pint Blood Deductible;
Part B 20% Coinsurance.
So, you see that these packages, if you're at all familiar with Medicare, are intended to supplement MEDICARE'S coverage, not your group health plan. Now, if you still have your group health plan, there could easily be overlapping coverage. In just about every situation in which there's group insurance and Medicare in place for a person, the group plan is the primary provider of coverage, with Medicare being secondary, or "excess" coverage. So, your claims would be submitted to your group carrier first and then to Medicare for their consideration. However, this is seriously tweaked by so many other things. Medicare has deductibles that must be met on both parts A & B of traditional Medicare. Will your co-pays exceed the deductibles? The hospital deductible (part A) for 2009 is $1,068 per occurrence (up $40 from 2008), and the part B deductible is $135 (same as last year).
I really don't see any need at this time to buy a MedSup policy. Your group plan and Medicare should be sufficient. In addition, if you want a MedSup policy, you'll have to be enrolled in both part A & B. You're now going to have to pay monthly premiums for part B coverage, which for most people is $96.40/month in 2009. If you make a lot of money, the premium's higher.
So...you could potentially be paying your group premiums, the medicare premiums, the MedSup premiums plus a host of other deductibles and whatnot for, ummm, you to save a $15 co-pay?
Hmmmmm.... I'm not sure that's such a great idea. :? But, to be perfectly fair, you should seek out the services of a competent professional ( I mean competent, not some "agent" who talks a good game). A good, GOOD place to discuss this is your states Senior Health insurance Assistance program, normally available through your state insurance commission. I have no idea what state you live in so I can't guide you.
I hope I helped, and if you need detailed info- go to my page in the Expert's Corner and leave me a pm with what you need.
InsTeacher 8)
Posted: Thu Apr 23, 2009 08:48 am Post Subject:
Yup, I would agree with Teacher. Medicare supplemental policies are to cover the gap in Medicare. It'd not support the private policy.
Medicare only pays a portion of the total medical cost of the enrollee, say 80%. The rest needs to be met by the recipient in terms of deductible and co-pay. Medical supplemental plan pays the gap left by the Medicare to minimize the senior's out-of-pocket expense. But unfortunately it'd not compensate for the non Medicare plan.
Hope it clarifies.
Thanks,
Rupert
Posted: Mon May 04, 2009 09:12 pm Post Subject:
I believe your question was will original Medicare help pay along with your private insurance (group coverage)? Your doctor will ask you which is your primary insurance and which is your secondary insurance. Most group policies differ, but you should check with your human resources department or your insurer to be exact.
Medicare pays 80% after their deductibles...and yes you can use it in conjunction with your group coverage.
BUT WHATEVER YOU DO>>>>
Do not sign up for a Medicare Advantage Plan (also called Medicare Part C) without knowing exactly what it would do to your group coverage. Even the application will tell you that it could negatively affect your group coverage.
Use your original Medicare and your group coverage, and if you retire and the group coverage is dropped (or you cannot afford increased premiums)...then and only then should you look at the Medicare Advantage plans. Even then, most of them don't cover that much...so be very careful. Medicare Supplements would be a good thing to consider at that point.
Let me know if you need any additional help.
Posted: Thu May 07, 2009 02:13 am Post Subject:
i wonder there would difference which one is our primary insurance and which one is the seconday insurance？ if medicare only pay 80percent after their deductibles. we should to pay that 20 percent personnaly or throw it to the secondary one? please clearify.
thanks and regards.
Posted: Thu May 07, 2009 09:32 am Post Subject:
You can either pay the deductible out-of-pocket or can have one of the several Medicare supplementary policies to cover the gap for you, if that's what you have meant by secondary policy.
Posted: Thu May 07, 2009 04:08 pm Post Subject:
When I worked for United Health Care the rule was that Medicare is ALWAYS the secondary insurance for an eligible senior citizen.
Even so, if you don't have Part B, regular doctor visits wouldn't be covered anyway... So the answer to your question is what teacher says...No. I also agree with him regarding getting a Med Sup policy... doesn't seem necessary.
Btw...The claims should be sent to Medicare even if Medicare isn't going to pay, because they may be applied towards your "deductible".
Posted: Fri May 08, 2009 05:16 am Post Subject:
When I worked for United Health Care the rule was that Medicare is ALWAYS the secondary insurance for an eligible senior citizen.
Does it mean that Medicare would play the secondary role to the existing coverage? How the primary and secondary coverage are determined?
Posted: Sat May 09, 2009 06:53 am Post Subject:
Kelvin,
Here's a good site that should help you with why Medicare is always secondary:
http://www.cms.hhs.gov/providerservices/06_grouphealthinsurance.asp
There are a lot of factors the Insurers use to determine primary/secondary coverage for anyone else... for example working spouses (where children are covered under both).
I could tell you that UHC used the spouses b-months among other things as criteria.
Posted: Thu May 27, 2010 04:35 am Post Subject: Medicare Part A
If my primary insurance covers 90% of hospitalization, will Medicare Part A cover the remaining 10% or nothing if they only cover up to 80%?
Posted: Tue Nov 30, 2010 05:35 am Post Subject: medicare vs grp hlth
duh..can't bee leave i'm such a dummy..m'care book says can sign up any time if have grp hlth thru work..my sweetie works & i'm undr 65 but disabled. 2day spoke to a m'care rep..told me co pays arn't covrd by m'care...depends..worked many yrs doing all kind of Cob w/m'care..lots of different ways..depending on policy wording..now i have to find out what 2 do..since i signed up quite a few years ago..& probably shouln't have...
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