I assumed that, when you are on Medicare and have medical care (e.g. Dr.'s visit), you give your Medicare card and your Medicare Supplement Insurance (MSI) card to the Doctor and then they billed both Medicare and your MSI separately.
Someone just told me that that is not how it works. They said that the Doctor only bills Medicare, then Medicare bills the MSI for any extra coverage. This means that the Doctor doesn’t need to know who your MSI company is, and that billing is simpler for him.
So I’m confused. Does anyone have expert knowledge on how this works? Does everything go thru Medicare, or do I have to give 2 medical cards to the Doctor and they have to bill 2 places?
If it is the latter, shopping for MSI should be primarily driven by price. Why pay more for a policy when the policies are identical (by law) and Medicare does all of the billing to the MSI?
In my experience, it is the medical provider who has the responsibility to bill both Medicare and your supplemental insurance carrier. Medicare will share the amount of their payment with the supplemental carrier thus allowing them to calculate their payment, if any.
The policies are not identical because Medicare is primary and your supplemental policy is secondary meaning the secondary policy only becomes involved after the primary policy concludes its limit of payment. After Medicare pays it has no further interest in the independent payments of a secondary carrier.
Do not limit your MSI shopping criteria to price only because the benefits are equally important.
Thanks for the reply. The above statement however needs clarification. The government (i.e. Medicare) specifies what each of the MSI “Plans” must cover, so any company that offers MSI insurance will cover the exact same things for the same “Plan”. On the other hand, if you meant “benefits” to mean how easy they are to deal with, how quickly they respond, etc. then yes you are correct.
As of 2005, they should. You have to sign up at the supplemental insurance company for this to happen, but once you do the crossover of claims should be automatic.
However, the healthcare provider must give Medicare the supplemental insurance company information on the claim so Medicare knows where to send it.
The core benefits of the policies are identical- fill the gaping holes in coverage that Medicare has, but there are differences. Does “Tom” have a thick Indian accent when you call customer service? Do they have a discount on fitness center memberships? Coverage for anything that Medicare does not cover, like out of country services?
Once crossover is set up, the provider should only have to file a claim to Medicare and the claim will be “crossed over” to the supplemental provider.
Like they said. The doctor bills Medicare and lets them know who your secondary is. Medicare then pays their portion and ideally sends it on to the secondary insurance who pays their portion. Both report back to you and the doctor who then bills any tertiary or quaternary insurances and then bills you for the balance. This is ideally how it works.
In practice, Medicare screws up the crossover and the doctor ends up calling everybody to sort out the mess. In addition, the EOB (explanation of benefits) from the secondary inexplicably does not note how much Medicare has paid.
For a $100 charge, you would think you should get a Medicare EOB saying:
Billed $100
Medicare allowance $80
Sent to secondary $20
Actually, the coverage benefits between MSI policies are similar but my experience shows they are not quite identical. I am currently comparing two MSI policies with a premium difference of about $20 per month. The more expensive policy leaves me with no out of pocket expense for doctor visits or hospital stays up to 100 days. The less costly policy has me paying co-payments for a office visit/hospital stay, Medicare Part B Deductible and any Medicare Part B Excess amounts.
These policies are being offered through the USAA site giving me some confidence in the reliability of their information. Many sites offering MSI coverage provide the opportunity to compare different policies side by side which is the method I used to judge policy coverage. However, if you have done this and found absolutely no deviation in coverage, then your approach of shopping by premium only should serve you well. Unfortunately, my research has not produced similar results.
The one with no out-of-pocket policy sounds like “Plan F”. The copay one sounds like “Plan N”. The Plans specified by the government are Plans A, B, C, D, F, G, K, L, M, and N. I believe that the exact coverage of these plans is specified by Medicare. The monthly payment of these plans will differ because they cover different things. The monthly payment of the same Plan from different companies will also differ. All companies (who want to offer MSIs) are not required to offer all plans, except if they offer any, they must offer Plan A.