Secondary Insurance: It’s Why Medicare Works
The Medicare secondary payer term is used if ever the medicare payments that are paid after the primary insurance company decides to make their determination towards payment. You may even hear this term also referred to as the MSP. It is required by the primary payer to make the primary payment towards the claim that is in the accordance with all of the coverage of its contract. This Medicare secondary insurance can be quite helpful for those who are mostly living off of a fixed income.
Should the primary payer start the claim and it for whatever reason does not pay in full for any services provided the benefits of the secondary insurance may just be paid for the services. Medicare would be considered the secondary should the beneficiary be covered under or by other insurance plans. You will have the following:
- Comprehensive medical coverage
- No more worrying about what tomorrow will be like
- Terrific preventive care coverage
- Office visits will be covered at 100 percent
Some of the other insurance plans would be a group health insurance, which would be insurance that is provided by an employer and given to the policy holder who must be actively working. There is automobile and liability insurance which is applicable with such cases where an accident occurs.
Should someone ever get hurt while working on the job there is workers compensation. The carrier of the employers workmen’s compensation is fully responsible for this type of claim. Any services that are rendered from the veterans Administration will not be covered under Medigap so if there are any services that are rendered through a non-VA facility the medicare insurance could consider any payment in regard to any covered from the services rendered which the VA did not pay into.
There are benefits that are covered from an employer from a heath plan through one that is their own or a member of the families present or past employer, then this would make medicare the secondary for up to a 30 month period for benefits that are entitled to medicare which is only based on ESRD, which is End Stage Of Renal Disease.
Sometimes there is some real confusion about medicare secondary payer as it is thought to be a medicare supplement, which is referred to as Medigap insurance, which is really a private health insurance policy which was designed just to fill in many of the gaps that is involved with the medicare coverage when medicare is then considered the primary payer.
Insurance plans such as the Medigap insurance plans< are the one that are considered to be the secondary payer for medicare. This type of insurance will pay the benefits for when medicare pays the claim by being the primary insurer. The insurance that is provided by a group health policy is given by an employer for a policy holder who is only actively working for the employer.
It is always the coordination of the benefits contractor which consolidates all of the activities which support the collection and also the reporting in regard to other insurance companies for the medicare benefits. Sometimes its necessary for any supplier to contact the CMS for verification should medicare be the secondary or even the primary payer or even to report some beneficiaries injury or accident.