Medicare As Secondary Payer to Group Health

Jun 21, 2016

  1. somarco
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    somarco That Medicare Expert Guy

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    I ran this by some of my group health buddies and no one knew. Figured I would toss this out to Medicare experts.

    Group HDHP with $3,000 deductible. Medicare Part B deductible is $166.

    Covered participant has group primary, Medicare B secondary.

    Incurs $1,000 (par provider, adjudicated and repriced) outpatient claim. Submitted to carrier. Carrier applies $1000 towards deductible, pays nothing.

    If claimant had only Medicare then Medicare would pay 80% less deductible.

    But since there is a group plan in place, and the plan paid nothing, my premise is Medicare would likewise pay nothing.

    True or faulty thinking?
     
    somarco, Jun 21, 2016
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  2. rcduggan
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    rcduggan Super Genius

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    These are rules of coordination of benefits. Employer sponsored plan would be considered primary and the Medicare secondary. If both plans have deductibles, you will have to satisfy them in order to have both pay. Secondary plan will not pay towards Primary plan's deductible but can pay towards anything uncovered. In my experience dual coverage is never cost effective. Also Medicare can't be compared to an employer group plan in any way.
     
    rcduggan, Jun 21, 2016
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  3. somarco
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    somarco That Medicare Expert Guy

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    Thank you RCDuggan for confirming my suspicion.

    The little bit I have found about COB between group health and Medicare seem to track COB where two different group plans are involved.

    In another thread the agent's prospect was told by the employer they didn't need Part B but the person wanted it anyway to cover their deductible.

    Dual coverage, whether group + Medicare or group + group almost always is a waste of $$$
     
    somarco, Jun 21, 2016
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