Medicare as secondary payer

A

Allisa35

Member
Hopefully someone out there can answer my questions. I will begin receiving Medicare as of 1-1-09. My husband's insurance will be primary (from what I udnerstand) and Medicare secondary. I spoke to someone at Social Security and they said that since I have insurance through a group health plan I don't have to enroll in Part B at this time and that I could sign up at a later time without being penalized regarding cost.

I am wondering if it would be worth it for me to sign up for Part B or if I should wait. I know the cost per month is $96.00. I am wondering what they cover. Here are my questions.

1. From reading through the book they sent me, it says they don't cover routine physicals. Does this mean Part B will not cover the co-pay amount (after my primary ins.) for a dr. visit? And if it is covered, would it apply toward the deductible?

2. The book indicates that for clinical labs services, I would pay 0 for medicare-approved services. Does this include sputums & blood work?

3. What do they consider Outpatient hospital services? Would this be x-rays, certain procedures? The book says they will pay a coninsurance or copayment amount that varies by service. Does anybody know what those payments would be?

I know that is a lot of questions, but I'm just trying to figure this out. I don't know whether it would be cost effective for me to take Part B if they aren't going to
cover anything. Any suggestions would be appreciated.
 
A

Allisa35

Member
Hopefully someone out there can answer my questions. I will begin receiving Medicare as of 1-1-09. My husband's insurance will be primary (from what I udnerstand) and Medicare secondary. I spoke to someone at Social Security and they said that since I have insurance through a group health plan I don't have to enroll in Part B at this time and that I could sign up at a later time without being penalized regarding cost.

I am wondering if it would be worth it for me to sign up for Part B or if I should wait. I know the cost per month is $96.00. I am wondering what they cover. Here are my questions.

1. From reading through the book they sent me, it says they don't cover routine physicals. Does this mean Part B will not cover the co-pay amount (after my primary ins.) for a dr. visit? And if it is covered, would it apply toward the deductible?

2. The book indicates that for clinical labs services, I would pay 0 for medicare-approved services. Does this include sputums & blood work?

3. What do they consider Outpatient hospital services? Would this be x-rays, certain procedures? The book says they will pay a coninsurance or copayment amount that varies by service. Does anybody know what those payments would be?

I know that is a lot of questions, but I'm just trying to figure this out. I don't know whether it would be cost effective for me to take Part B if they aren't going to
cover anything. Any suggestions would be appreciated.
 
A

Allisa35

Member
Hopefully someone out there can answer my questions. I will begin receiving Medicare as of 1-1-09. My husband's insurance will be primary (from what I udnerstand) and Medicare secondary. I spoke to someone at Social Security and they said that since I have insurance through a group health plan I don't have to enroll in Part B at this time and that I could sign up at a later time without being penalized regarding cost.

I am wondering if it would be worth it for me to sign up for Part B or if I should wait. I know the cost per month is $96.00. I am wondering what they cover. Here are my questions.

1. From reading through the book they sent me, it says they don't cover routine physicals. Does this mean Part B will not cover the co-pay amount (after my primary ins.) for a dr. visit? And if it is covered, would it apply toward the deductible?

2. The book indicates that for clinical labs services, I would pay 0 for medicare-approved services. Does this include sputums & blood work?

3. What do they consider Outpatient hospital services? Would this be x-rays, certain procedures? The book says they will pay a coninsurance or copayment amount that varies by service. Does anybody know what those payments would be?

I know that is a lot of questions, but I'm just trying to figure this out. I don't know whether it would be cost effective for me to take Part B if they aren't going to
cover anything. Any suggestions would be appreciated.
 
A

Allisa35

Member
Hopefully someone out there can answer my questions. I will begin receiving Medicare as of 1-1-09. My husband's insurance will be primary (from what I udnerstand) and Medicare secondary. I spoke to someone at Social Security and they said that since I have insurance through a group health plan I don't have to enroll in Part B at this time and that I could sign up at a later time without being penalized regarding cost.

I am wondering if it would be worth it for me to sign up for Part B or if I should wait. I know the cost per month is $96.00. I am wondering what they cover. Here are my questions.

1. From reading through the book they sent me, it says they don't cover routine physicals. Does this mean Part B will not cover the co-pay amount (after my primary ins.) for a dr. visit? And if it is covered, would it apply toward the deductible?

2. The book indicates that for clinical labs services, I would pay 0 for medicare-approved services. Does this include sputums & blood work?

3. What do they consider Outpatient hospital services? Would this be x-rays, certain procedures? The book says they will pay a coninsurance or copayment amount that varies by service. Does anybody know what those payments would be?

I know that is a lot of questions, but I'm just trying to figure this out. I don't know whether it would be cost effective for me to take Part B if they aren't going to
cover anything. Any suggestions would be appreciated.
 
A

Allisa35

Member
Hopefully someone out there can answer my questions. I will begin receiving Medicare as of 1-1-09. My husband's insurance will be primary (from what I udnerstand) and Medicare secondary. I spoke to someone at Social Security and they said that since I have insurance through a group health plan I don't have to enroll in Part B at this time and that I could sign up at a later time without being penalized regarding cost.
<br />
<br />I am wondering if it would be worth it for me to sign up for Part B or if I should wait. I know the cost per month is $96.00. I am wondering what they cover. Here are my questions.
<br />
<br />1. From reading through the book they sent me, it says they don't cover routine physicals. Does this mean Part B will not cover the co-pay amount (after my primary ins.) for a dr. visit? And if it is covered, would it apply toward the deductible?
<br />
<br />2. The book indicates that for clinical labs services, I would pay 0 for medicare-approved services. Does this include sputums & blood work?
<br />
<br />3. What do they consider Outpatient hospital services? Would this be x-rays, certain procedures? The book says they will pay a coninsurance or copayment amount that varies by service. Does anybody know what those payments would be?
<br />
<br />I know that is a lot of questions, but I'm just trying to figure this out. I don't know whether it would be cost effective for me to take Part B if they aren't going to
<br />cover anything. Any suggestions would be appreciated.
<br />
 
S

Skye

New member
I am trying to figure this out too.....so I hope you get some good answers. I have made some attempts to figure some of this out....but, I am not positive of anything. I think Medicare part B will also cover some meds. Meds that have to be used with what they classify as durable medical equipment ie compressor, insulin pump. So I THINK things like pulmozyme, Tobi, Collistin, insulin in a pump MAY be covered. Though I think some people have had SOME difficulty with this coverage lately?????

I think they may also cover some oral transplant medications that are needed under Part B.

Sorry I can't be more help. I hope you get some good responses.
 
S

Skye

New member
I am trying to figure this out too.....so I hope you get some good answers. I have made some attempts to figure some of this out....but, I am not positive of anything. I think Medicare part B will also cover some meds. Meds that have to be used with what they classify as durable medical equipment ie compressor, insulin pump. So I THINK things like pulmozyme, Tobi, Collistin, insulin in a pump MAY be covered. Though I think some people have had SOME difficulty with this coverage lately?????

I think they may also cover some oral transplant medications that are needed under Part B.

Sorry I can't be more help. I hope you get some good responses.
 
S

Skye

New member
I am trying to figure this out too.....so I hope you get some good answers. I have made some attempts to figure some of this out....but, I am not positive of anything. I think Medicare part B will also cover some meds. Meds that have to be used with what they classify as durable medical equipment ie compressor, insulin pump. So I THINK things like pulmozyme, Tobi, Collistin, insulin in a pump MAY be covered. Though I think some people have had SOME difficulty with this coverage lately?????

I think they may also cover some oral transplant medications that are needed under Part B.

Sorry I can't be more help. I hope you get some good responses.
 
S

Skye

New member
I am trying to figure this out too.....so I hope you get some good answers. I have made some attempts to figure some of this out....but, I am not positive of anything. I think Medicare part B will also cover some meds. Meds that have to be used with what they classify as durable medical equipment ie compressor, insulin pump. So I THINK things like pulmozyme, Tobi, Collistin, insulin in a pump MAY be covered. Though I think some people have had SOME difficulty with this coverage lately?????

I think they may also cover some oral transplant medications that are needed under Part B.

Sorry I can't be more help. I hope you get some good responses.
 
S

Skye

New member
I am trying to figure this out too.....so I hope you get some good answers. I have made some attempts to figure some of this out....but, I am not positive of anything. I think Medicare part B will also cover some meds. Meds that have to be used with what they classify as durable medical equipment ie compressor, insulin pump. So I THINK things like pulmozyme, Tobi, Collistin, insulin in a pump MAY be covered. Though I think some people have had SOME difficulty with this coverage lately?????
<br />
<br />I think they may also cover some oral transplant medications that are needed under Part B.
<br />
<br />Sorry I can't be more help. I hope you get some good responses.
 
J

JazzysMom

New member
I have insurance through my husband as primary. I did sign up for Medicare Part B, but not Part D for prescriptions.

Medicare will NOT pay on any copays from your primary. So the doctors, xrays etc that have co pays they will NOT pay on. I signed up for Part B because my CF doctor is not actually contracted with my insurance. SO when I go I have a CO INSURANCE (80/20 of charges) not a CO PAY (flat rate of $18. for office visits) & Medicare WILL cover this.

Lab work is covered 100% by medicare instead of the 80/20 % IF they pay after your primary. Again back to the copay versus co insurance again.


I am not 100% sure on Medicare Part D, but I would think its along the same lines. THey wont pay if you only have a co pay on meds.


Outpatient is doctors, emergency room, labs, dianosti testing, same day surgery. Doctors are ALWAYS outpatient, but the others can be considered inpatient if they take place during or lead up to an actual admission,

Your responsibility under outpatient is after the outpatient deductable & then the 80/20 of charges is determined. Often Medicare will deny if your primary deems that they wont pay also.

I think I covered your general ??. If you need clarification on anything or have additional ?? give a shout!
 
J

JazzysMom

New member
I have insurance through my husband as primary. I did sign up for Medicare Part B, but not Part D for prescriptions.

Medicare will NOT pay on any copays from your primary. So the doctors, xrays etc that have co pays they will NOT pay on. I signed up for Part B because my CF doctor is not actually contracted with my insurance. SO when I go I have a CO INSURANCE (80/20 of charges) not a CO PAY (flat rate of $18. for office visits) & Medicare WILL cover this.

Lab work is covered 100% by medicare instead of the 80/20 % IF they pay after your primary. Again back to the copay versus co insurance again.


I am not 100% sure on Medicare Part D, but I would think its along the same lines. THey wont pay if you only have a co pay on meds.


Outpatient is doctors, emergency room, labs, dianosti testing, same day surgery. Doctors are ALWAYS outpatient, but the others can be considered inpatient if they take place during or lead up to an actual admission,

Your responsibility under outpatient is after the outpatient deductable & then the 80/20 of charges is determined. Often Medicare will deny if your primary deems that they wont pay also.

I think I covered your general ??. If you need clarification on anything or have additional ?? give a shout!
 
J

JazzysMom

New member
I have insurance through my husband as primary. I did sign up for Medicare Part B, but not Part D for prescriptions.

Medicare will NOT pay on any copays from your primary. So the doctors, xrays etc that have co pays they will NOT pay on. I signed up for Part B because my CF doctor is not actually contracted with my insurance. SO when I go I have a CO INSURANCE (80/20 of charges) not a CO PAY (flat rate of $18. for office visits) & Medicare WILL cover this.

Lab work is covered 100% by medicare instead of the 80/20 % IF they pay after your primary. Again back to the copay versus co insurance again.


I am not 100% sure on Medicare Part D, but I would think its along the same lines. THey wont pay if you only have a co pay on meds.


Outpatient is doctors, emergency room, labs, dianosti testing, same day surgery. Doctors are ALWAYS outpatient, but the others can be considered inpatient if they take place during or lead up to an actual admission,

Your responsibility under outpatient is after the outpatient deductable & then the 80/20 of charges is determined. Often Medicare will deny if your primary deems that they wont pay also.

I think I covered your general ??. If you need clarification on anything or have additional ?? give a shout!
 
J

JazzysMom

New member
I have insurance through my husband as primary. I did sign up for Medicare Part B, but not Part D for prescriptions.

Medicare will NOT pay on any copays from your primary. So the doctors, xrays etc that have co pays they will NOT pay on. I signed up for Part B because my CF doctor is not actually contracted with my insurance. SO when I go I have a CO INSURANCE (80/20 of charges) not a CO PAY (flat rate of $18. for office visits) & Medicare WILL cover this.

Lab work is covered 100% by medicare instead of the 80/20 % IF they pay after your primary. Again back to the copay versus co insurance again.


I am not 100% sure on Medicare Part D, but I would think its along the same lines. THey wont pay if you only have a co pay on meds.


Outpatient is doctors, emergency room, labs, dianosti testing, same day surgery. Doctors are ALWAYS outpatient, but the others can be considered inpatient if they take place during or lead up to an actual admission,

Your responsibility under outpatient is after the outpatient deductable & then the 80/20 of charges is determined. Often Medicare will deny if your primary deems that they wont pay also.

I think I covered your general ??. If you need clarification on anything or have additional ?? give a shout!
 
J

JazzysMom

New member
I have insurance through my husband as primary. I did sign up for Medicare Part B, but not Part D for prescriptions.
<br />
<br />Medicare will NOT pay on any copays from your primary. So the doctors, xrays etc that have co pays they will NOT pay on. I signed up for Part B because my CF doctor is not actually contracted with my insurance. SO when I go I have a CO INSURANCE (80/20 of charges) not a CO PAY (flat rate of $18. for office visits) & Medicare WILL cover this.
<br />
<br />Lab work is covered 100% by medicare instead of the 80/20 % IF they pay after your primary. Again back to the copay versus co insurance again.
<br />
<br />
<br />I am not 100% sure on Medicare Part D, but I would think its along the same lines. THey wont pay if you only have a co pay on meds.
<br />
<br />
<br />Outpatient is doctors, emergency room, labs, dianosti testing, same day surgery. Doctors are ALWAYS outpatient, but the others can be considered inpatient if they take place during or lead up to an actual admission,
<br />
<br />Your responsibility under outpatient is after the outpatient deductable & then the 80/20 of charges is determined. Often Medicare will deny if your primary deems that they wont pay also.
<br />
<br />I think I covered your general ??. If you need clarification on anything or have additional ?? give a shout!
 
T

Transplantmommy

New member
I have had Medicare as a secondary since March of this year and I still don't have it all figured out. I do know that I have Part A and B and I pay $96/month that comes directly out of my disability check. I do not have part D for prescriptions because my husband's insurance is pretty good with those.

As for the co-pays and co-insurance, I have to meet a deductible for Medicare (or I'm pretty sure that's how it goes) and after I meet that deductible, Medicare covers everything. I can tell you that since having Medicare, I have not paid the $15 co-pay at my GP's office.

As for the physicals, I have not had one since I had Medicare but yeah, in the book it says that they won't pay for them. I also have to get a Mammogram every year (due to having the transplants) and I don't think Medicare covers those either unless you are of a certain age.

Like I said, I don't have it all figured out yet. I hope that you get it figured out.
 
T

Transplantmommy

New member
I have had Medicare as a secondary since March of this year and I still don't have it all figured out. I do know that I have Part A and B and I pay $96/month that comes directly out of my disability check. I do not have part D for prescriptions because my husband's insurance is pretty good with those.

As for the co-pays and co-insurance, I have to meet a deductible for Medicare (or I'm pretty sure that's how it goes) and after I meet that deductible, Medicare covers everything. I can tell you that since having Medicare, I have not paid the $15 co-pay at my GP's office.

As for the physicals, I have not had one since I had Medicare but yeah, in the book it says that they won't pay for them. I also have to get a Mammogram every year (due to having the transplants) and I don't think Medicare covers those either unless you are of a certain age.

Like I said, I don't have it all figured out yet. I hope that you get it figured out.
 
T

Transplantmommy

New member
I have had Medicare as a secondary since March of this year and I still don't have it all figured out. I do know that I have Part A and B and I pay $96/month that comes directly out of my disability check. I do not have part D for prescriptions because my husband's insurance is pretty good with those.

As for the co-pays and co-insurance, I have to meet a deductible for Medicare (or I'm pretty sure that's how it goes) and after I meet that deductible, Medicare covers everything. I can tell you that since having Medicare, I have not paid the $15 co-pay at my GP's office.

As for the physicals, I have not had one since I had Medicare but yeah, in the book it says that they won't pay for them. I also have to get a Mammogram every year (due to having the transplants) and I don't think Medicare covers those either unless you are of a certain age.

Like I said, I don't have it all figured out yet. I hope that you get it figured out.
 
T

Transplantmommy

New member
I have had Medicare as a secondary since March of this year and I still don't have it all figured out. I do know that I have Part A and B and I pay $96/month that comes directly out of my disability check. I do not have part D for prescriptions because my husband's insurance is pretty good with those.

As for the co-pays and co-insurance, I have to meet a deductible for Medicare (or I'm pretty sure that's how it goes) and after I meet that deductible, Medicare covers everything. I can tell you that since having Medicare, I have not paid the $15 co-pay at my GP's office.

As for the physicals, I have not had one since I had Medicare but yeah, in the book it says that they won't pay for them. I also have to get a Mammogram every year (due to having the transplants) and I don't think Medicare covers those either unless you are of a certain age.

Like I said, I don't have it all figured out yet. I hope that you get it figured out.
 
T

Transplantmommy

New member
I have had Medicare as a secondary since March of this year and I still don't have it all figured out. I do know that I have Part A and B and I pay $96/month that comes directly out of my disability check. I do not have part D for prescriptions because my husband's insurance is pretty good with those.
<br />
<br />As for the co-pays and co-insurance, I have to meet a deductible for Medicare (or I'm pretty sure that's how it goes) and after I meet that deductible, Medicare covers everything. I can tell you that since having Medicare, I have not paid the $15 co-pay at my GP's office.
<br />
<br />As for the physicals, I have not had one since I had Medicare but yeah, in the book it says that they won't pay for them. I also have to get a Mammogram every year (due to having the transplants) and I don't think Medicare covers those either unless you are of a certain age.
<br />
<br />Like I said, I don't have it all figured out yet. I hope that you get it figured out.
 
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