by Clarkellen1 » Wed Dec 01, 2010 10:58 pm
Can my 84 year old mother have private insurance (AvMed) as her primary and Medicare as her secondary insurance? I have never heard of this, but she insists that is what she has.
Posted: Thu Dec 02, 2010 06:29 am Post Subject:
If your mother has the AvMed Medicare Advantage Plan called "Premier Care HMO", that is her only coverage. She no longer has "Original Medicare Parts A & B", but has substituted the senior HMO for them.
I doubt that she has any of the other plans AvMed offers. Her misunderstanding is common. Like all others on a Medicare Advantage Plan, she still pays the Part B monthly premium ($96.40 for her in 2010, and no increase coming again in 2011) which may lead her to think she still has different coverage from Medicare in addition to the HMO.
Her HMO will probably cover more things than Original Medicare does, so let her think what she believes is true. No need to argue about it.
Posted: Thu Dec 02, 2010 06:37 am Post Subject:
I'd come across an article which stated that Medicare can be a secondary payer based on a number of factors. It states that if we're over 65 and belong to a group health plan, then Medicare can be a secondary payer.
Posted: Sat Dec 04, 2010 03:08 am Post Subject:
Yes, that's correct. If you have any other form of personal coverage -- group or individual (or Worker's Comp) -- Medicare will be secondary to that coverage. Anything that can take the government off the hook for an old person's medical bills, they leverage to their advantage.
The good news is, those other coverages probably provide better benefits than Medicare does in the first place. But if something is not covered 100%, then the balance can be billed to Medicare and if it's "medically-necessary", then Medicare will pay some or all of the unpaid balance.
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