If I Am Hospitalized, Does My Medicare Pay First Before My Health Insurance?
Individuals who are hospitalized and are on Medicare as well as other health insurance coverage may not know what insurance coverage will pay first. There are certain circumstances in which Medicare will be the primary payer for health costs and others when it will be the secondary payer. Medicare is always the secondary payer if an individual has a group health insurance policy. Individuals should notify their health care providers of their health insurance coverages in addition to Medicare.
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Group Health Coverage
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When an individual is included on a group health insurance plan as well as Medicare hospital costs, the group health plan will pay first in certain circumstances. A group health insurance plan will pay costs first when an individual is over the age of 65 and if group coverage is currently available with an employer. A group health plan will also pay first when an employer has 20 or more employees and their health plan covers any service that is provided by Medicare.
No-Fault or Liability Insurance
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No-fault insurance pays for health care services in the event of an accident or injury regardless of who is at fault. No-fault insurance can exist for automobile insurance and homeowners insurance as well as commercial insurance plans. Liability insurance can pay for medical expenses as the result of injury claims for negligence of the policyholder. No-fault or liability insurance will pay for health care costs first before Medicare.
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Workers' Compensation
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Workers' compensation insurance, according to a law that exists in all states, requires employers to provide benefits for employees who get sick or injured while on the job. Workers' compensation will pay first for any medical services or expenses as a result of the injury, such as a hospital stay. If a workers' compensation insurer denies a claim for a medical expense while a claim review is pending, a conditional payment may be made by Medicare.
Veterans' Benefits
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When an individual has Medicare as well as veterans' benefits either program can be used to pay for services such as a hospital stay. A choice needs to be made by an individual when seeing a doctor or receiving a health care service. Medicare will not pay for health care services that are covered by veterans' benefits and vice versa. Also, when veterans' benefits will not pay for certain types of services, Medicare will pay for what was not covered.
COBRA
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Individuals who have COBRA continuation coverage will have medical payments paid by Medicare first in certain situations. This is because the rules that apply to group health insurance plans offered by employers apply to COBRA continuation coverage as well. As a result, an individual with COBRA continuation coverage from an employer with less than 20 employees will have medical costs paid by Medicare first.
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