Medicare as secondary payer

A

Allisa35

Member
Thanks for your replies guys. I thought of a couple more questions; maybe JazzysMom might know (or anybody else).

If Medicare pays 80/20 for outpatient and my insurance pays 80% say for an x-ray, will Medicare then pick up the remaining 20% or will they pay 80% of the 20%. I am kind of confused about the outpatient & lab criteria. According to the book, it says anything for outpatient has a set copay amount depending on what the procedure is. Also, for home health, the book shows it being covered under Part A and Part B. Is there a difference between the coverage?

Part of me says that I should just hold off on getting Part B because I don't think it would really be cost effective for me (since I would have to pay $96/month and then the $135/deductible). Then there's the other part of me that thinks I should get in just in case. I just don't know what to do - I'm about ready to pull my hair out (lol)!!

Thanks!!
 
A

Allisa35

Member
Thanks for your replies guys. I thought of a couple more questions; maybe JazzysMom might know (or anybody else).

If Medicare pays 80/20 for outpatient and my insurance pays 80% say for an x-ray, will Medicare then pick up the remaining 20% or will they pay 80% of the 20%. I am kind of confused about the outpatient & lab criteria. According to the book, it says anything for outpatient has a set copay amount depending on what the procedure is. Also, for home health, the book shows it being covered under Part A and Part B. Is there a difference between the coverage?

Part of me says that I should just hold off on getting Part B because I don't think it would really be cost effective for me (since I would have to pay $96/month and then the $135/deductible). Then there's the other part of me that thinks I should get in just in case. I just don't know what to do - I'm about ready to pull my hair out (lol)!!

Thanks!!
 
A

Allisa35

Member
Thanks for your replies guys. I thought of a couple more questions; maybe JazzysMom might know (or anybody else).

If Medicare pays 80/20 for outpatient and my insurance pays 80% say for an x-ray, will Medicare then pick up the remaining 20% or will they pay 80% of the 20%. I am kind of confused about the outpatient & lab criteria. According to the book, it says anything for outpatient has a set copay amount depending on what the procedure is. Also, for home health, the book shows it being covered under Part A and Part B. Is there a difference between the coverage?

Part of me says that I should just hold off on getting Part B because I don't think it would really be cost effective for me (since I would have to pay $96/month and then the $135/deductible). Then there's the other part of me that thinks I should get in just in case. I just don't know what to do - I'm about ready to pull my hair out (lol)!!

Thanks!!
 
A

Allisa35

Member
Thanks for your replies guys. I thought of a couple more questions; maybe JazzysMom might know (or anybody else).

If Medicare pays 80/20 for outpatient and my insurance pays 80% say for an x-ray, will Medicare then pick up the remaining 20% or will they pay 80% of the 20%. I am kind of confused about the outpatient & lab criteria. According to the book, it says anything for outpatient has a set copay amount depending on what the procedure is. Also, for home health, the book shows it being covered under Part A and Part B. Is there a difference between the coverage?

Part of me says that I should just hold off on getting Part B because I don't think it would really be cost effective for me (since I would have to pay $96/month and then the $135/deductible). Then there's the other part of me that thinks I should get in just in case. I just don't know what to do - I'm about ready to pull my hair out (lol)!!

Thanks!!
 
A

Allisa35

Member
Thanks for your replies guys. I thought of a couple more questions; maybe JazzysMom might know (or anybody else).
<br />
<br />If Medicare pays 80/20 for outpatient and my insurance pays 80% say for an x-ray, will Medicare then pick up the remaining 20% or will they pay 80% of the 20%. I am kind of confused about the outpatient & lab criteria. According to the book, it says anything for outpatient has a set copay amount depending on what the procedure is. Also, for home health, the book shows it being covered under Part A and Part B. Is there a difference between the coverage?
<br />
<br />Part of me says that I should just hold off on getting Part B because I don't think it would really be cost effective for me (since I would have to pay $96/month and then the $135/deductible). Then there's the other part of me that thinks I should get in just in case. I just don't know what to do - I'm about ready to pull my hair out (lol)!!
<br />
<br />Thanks!!
 
J

JazzysMom

New member
IF your primary pays 80/20 then Medicare will pay 80/20 of the balance AFTER you meet your Medicare Outpatient deductable.

Part A is for INPATIENT charges. Any charges except doctors that are incurred during an admission like xray, labs, meds, room/board (obviously) etc is included in the admission charges. They pay 100% once you pay the HUGE inpatient deductable.

If you go to the lab any other time it is considered outpatient and is covered under Part B.

As far as home health I have never used my Medicare for it....but my understanding from others who only have Medicare is that IV's are NOT covered if done at home so I dont know if that includes ALL home health care or not.
 
J

JazzysMom

New member
IF your primary pays 80/20 then Medicare will pay 80/20 of the balance AFTER you meet your Medicare Outpatient deductable.

Part A is for INPATIENT charges. Any charges except doctors that are incurred during an admission like xray, labs, meds, room/board (obviously) etc is included in the admission charges. They pay 100% once you pay the HUGE inpatient deductable.

If you go to the lab any other time it is considered outpatient and is covered under Part B.

As far as home health I have never used my Medicare for it....but my understanding from others who only have Medicare is that IV's are NOT covered if done at home so I dont know if that includes ALL home health care or not.
 
J

JazzysMom

New member
IF your primary pays 80/20 then Medicare will pay 80/20 of the balance AFTER you meet your Medicare Outpatient deductable.

Part A is for INPATIENT charges. Any charges except doctors that are incurred during an admission like xray, labs, meds, room/board (obviously) etc is included in the admission charges. They pay 100% once you pay the HUGE inpatient deductable.

If you go to the lab any other time it is considered outpatient and is covered under Part B.

As far as home health I have never used my Medicare for it....but my understanding from others who only have Medicare is that IV's are NOT covered if done at home so I dont know if that includes ALL home health care or not.
 
J

JazzysMom

New member
IF your primary pays 80/20 then Medicare will pay 80/20 of the balance AFTER you meet your Medicare Outpatient deductable.

Part A is for INPATIENT charges. Any charges except doctors that are incurred during an admission like xray, labs, meds, room/board (obviously) etc is included in the admission charges. They pay 100% once you pay the HUGE inpatient deductable.

If you go to the lab any other time it is considered outpatient and is covered under Part B.

As far as home health I have never used my Medicare for it....but my understanding from others who only have Medicare is that IV's are NOT covered if done at home so I dont know if that includes ALL home health care or not.
 
J

JazzysMom

New member
IF your primary pays 80/20 then Medicare will pay 80/20 of the balance AFTER you meet your Medicare Outpatient deductable.
<br />
<br />Part A is for INPATIENT charges. Any charges except doctors that are incurred during an admission like xray, labs, meds, room/board (obviously) etc is included in the admission charges. They pay 100% once you pay the HUGE inpatient deductable.
<br />
<br />If you go to the lab any other time it is considered outpatient and is covered under Part B.
<br />
<br />As far as home health I have never used my Medicare for it....but my understanding from others who only have Medicare is that IV's are NOT covered if done at home so I dont know if that includes ALL home health care or not.
<br />
<br />
 
S

Skye

New member
Allisa....I hope you are still at the forum and can update us on what you decided to do. I am finding this Medicare thing to be a real mess. I opted to get Part B and I am wondering what the heck they do cover. I just spent an hour on the phone trying to sort this out.

Melissa, do you know if they cover any inhaled med copays under Part B? Medicare is secondary insurance for me and I was hoping they would pick up my $60 co-pay. I am finding out that may now be the case; but, don't want to give up if they are suppose to. Also, do they cover ANY of the $20 copay doc visits. It looks like they DID and DO for you Patti. Patti are any of your tx drugs covered under Part B?

HELP
 
S

Skye

New member
Allisa....I hope you are still at the forum and can update us on what you decided to do. I am finding this Medicare thing to be a real mess. I opted to get Part B and I am wondering what the heck they do cover. I just spent an hour on the phone trying to sort this out.

Melissa, do you know if they cover any inhaled med copays under Part B? Medicare is secondary insurance for me and I was hoping they would pick up my $60 co-pay. I am finding out that may now be the case; but, don't want to give up if they are suppose to. Also, do they cover ANY of the $20 copay doc visits. It looks like they DID and DO for you Patti. Patti are any of your tx drugs covered under Part B?

HELP
 
S

Skye

New member
Allisa....I hope you are still at the forum and can update us on what you decided to do. I am finding this Medicare thing to be a real mess. I opted to get Part B and I am wondering what the heck they do cover. I just spent an hour on the phone trying to sort this out.

Melissa, do you know if they cover any inhaled med copays under Part B? Medicare is secondary insurance for me and I was hoping they would pick up my $60 co-pay. I am finding out that may now be the case; but, don't want to give up if they are suppose to. Also, do they cover ANY of the $20 copay doc visits. It looks like they DID and DO for you Patti. Patti are any of your tx drugs covered under Part B?

HELP
 
S

Skye

New member
Allisa....I hope you are still at the forum and can update us on what you decided to do. I am finding this Medicare thing to be a real mess. I opted to get Part B and I am wondering what the heck they do cover. I just spent an hour on the phone trying to sort this out.

Melissa, do you know if they cover any inhaled med copays under Part B? Medicare is secondary insurance for me and I was hoping they would pick up my $60 co-pay. I am finding out that may now be the case; but, don't want to give up if they are suppose to. Also, do they cover ANY of the $20 copay doc visits. It looks like they DID and DO for you Patti. Patti are any of your tx drugs covered under Part B?

HELP
 
S

Skye

New member
Allisa....I hope you are still at the forum and can update us on what you decided to do. I am finding this Medicare thing to be a real mess. I opted to get Part B and I am wondering what the heck they do cover. I just spent an hour on the phone trying to sort this out.
<br />
<br />Melissa, do you know if they cover any inhaled med copays under Part B? Medicare is secondary insurance for me and I was hoping they would pick up my $60 co-pay. I am finding out that may now be the case; but, don't want to give up if they are suppose to. Also, do they cover ANY of the $20 copay doc visits. It looks like they DID and DO for you Patti. Patti are any of your tx drugs covered under Part B?
<br />
<br />HELP
 
L

Landy

New member
Skye,
I may be able to help you. I have Medicare part A&B as secondary.<i> If</i> I have to pay any of my doctor visit co-pay, it is very minimal. Same thing with diabetic supplies as long as a script is written for them. They do get picky on how many test strips per month they will cover, depending on how severe the diabetes is (i.e. they will only cover 1 test strip per day for me, so I get a container of 50 every 2 months). Again, IF I have to pay for any part of the test strips, it is very minimal (around $5.00)

They used to cover my Pulmicort & Xopenex co-pays, but last year, they said that they will only pay for those meds for a COPD or emphysema diagnosis (go figure?). Not sure about 2009, but assume it's the same.

Unless things have changed, your nebulized antibiotics should be covered under Part B. I no longer use TOBI or Pulmozyme, so am not 100% sure on these.

Yes, Mel is correct--they will not cover home IVs, IV supplies, etc. but I'm pretty sure that they cover the home health nurse that comes to my house to help me get started with IVs.

It is very confusing to try to figure out what is & isn't covered<img src="i/expressions/face-icon-small-confused.gif" border="0">
 
L

Landy

New member
Skye,
I may be able to help you. I have Medicare part A&B as secondary.<i> If</i> I have to pay any of my doctor visit co-pay, it is very minimal. Same thing with diabetic supplies as long as a script is written for them. They do get picky on how many test strips per month they will cover, depending on how severe the diabetes is (i.e. they will only cover 1 test strip per day for me, so I get a container of 50 every 2 months). Again, IF I have to pay for any part of the test strips, it is very minimal (around $5.00)

They used to cover my Pulmicort & Xopenex co-pays, but last year, they said that they will only pay for those meds for a COPD or emphysema diagnosis (go figure?). Not sure about 2009, but assume it's the same.

Unless things have changed, your nebulized antibiotics should be covered under Part B. I no longer use TOBI or Pulmozyme, so am not 100% sure on these.

Yes, Mel is correct--they will not cover home IVs, IV supplies, etc. but I'm pretty sure that they cover the home health nurse that comes to my house to help me get started with IVs.

It is very confusing to try to figure out what is & isn't covered<img src="i/expressions/face-icon-small-confused.gif" border="0">
 
L

Landy

New member
Skye,
I may be able to help you. I have Medicare part A&B as secondary.<i> If</i> I have to pay any of my doctor visit co-pay, it is very minimal. Same thing with diabetic supplies as long as a script is written for them. They do get picky on how many test strips per month they will cover, depending on how severe the diabetes is (i.e. they will only cover 1 test strip per day for me, so I get a container of 50 every 2 months). Again, IF I have to pay for any part of the test strips, it is very minimal (around $5.00)

They used to cover my Pulmicort & Xopenex co-pays, but last year, they said that they will only pay for those meds for a COPD or emphysema diagnosis (go figure?). Not sure about 2009, but assume it's the same.

Unless things have changed, your nebulized antibiotics should be covered under Part B. I no longer use TOBI or Pulmozyme, so am not 100% sure on these.

Yes, Mel is correct--they will not cover home IVs, IV supplies, etc. but I'm pretty sure that they cover the home health nurse that comes to my house to help me get started with IVs.

It is very confusing to try to figure out what is & isn't covered<img src="i/expressions/face-icon-small-confused.gif" border="0">
 
L

Landy

New member
Skye,
I may be able to help you. I have Medicare part A&B as secondary.<i> If</i> I have to pay any of my doctor visit co-pay, it is very minimal. Same thing with diabetic supplies as long as a script is written for them. They do get picky on how many test strips per month they will cover, depending on how severe the diabetes is (i.e. they will only cover 1 test strip per day for me, so I get a container of 50 every 2 months). Again, IF I have to pay for any part of the test strips, it is very minimal (around $5.00)

They used to cover my Pulmicort & Xopenex co-pays, but last year, they said that they will only pay for those meds for a COPD or emphysema diagnosis (go figure?). Not sure about 2009, but assume it's the same.

Unless things have changed, your nebulized antibiotics should be covered under Part B. I no longer use TOBI or Pulmozyme, so am not 100% sure on these.

Yes, Mel is correct--they will not cover home IVs, IV supplies, etc. but I'm pretty sure that they cover the home health nurse that comes to my house to help me get started with IVs.

It is very confusing to try to figure out what is & isn't covered<img src="i/expressions/face-icon-small-confused.gif" border="0">
 
L

Landy

New member
Skye,
<br />I may be able to help you. I have Medicare part A&B as secondary.<i> If</i> I have to pay any of my doctor visit co-pay, it is very minimal. Same thing with diabetic supplies as long as a script is written for them. They do get picky on how many test strips per month they will cover, depending on how severe the diabetes is (i.e. they will only cover 1 test strip per day for me, so I get a container of 50 every 2 months). Again, IF I have to pay for any part of the test strips, it is very minimal (around $5.00)
<br />
<br />They used to cover my Pulmicort & Xopenex co-pays, but last year, they said that they will only pay for those meds for a COPD or emphysema diagnosis (go figure?). Not sure about 2009, but assume it's the same.
<br />
<br />Unless things have changed, your nebulized antibiotics should be covered under Part B. I no longer use TOBI or Pulmozyme, so am not 100% sure on these.
<br />
<br />Yes, Mel is correct--they will not cover home IVs, IV supplies, etc. but I'm pretty sure that they cover the home health nurse that comes to my house to help me get started with IVs.
<br />
<br />It is very confusing to try to figure out what is & isn't covered<img src="i/expressions/face-icon-small-confused.gif" border="0">
 
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