Does Medicare And My Supplemental Insurance Work Together?





Medicare Supplemental Insurance

The Medicare program specifies what coverage needs to be provided for an insurance policy to be defined as a Medicare supplement. This includes mandated coverage of deductibles, coinsurance obligations, and/or extended benefits. There are a number of categories of approved Medicare supplementary benefits that an insurer needs to provide in order to qualify as being called a Medicare supplement. Those that meet these requirements can positively answer the question, “Does Medicare and my supplemental insurance work together?”

Most, if not all, officially recognized Medicare supplemental policies are digitally connected to Medicare’s local agencies that process claims. Once Medicare adjudicates a claim, the local agent will transmit that information directly to the supplemental insurer for further processing. The patient is not normally involved in these transactions. Claims are processed and paid without any intervention. If you ask, “Does Medicare and my supplemental insurance work together?” the answer is yes because both parties have a contractual obligation to do so.

Some Medicare Supplements Are Not Supplemental Policies

Patients who rely on policies retained after retirement, spouses’ insurance, or unofficial Medicare supplements do not get claim information automatically transmitted from Medicare when claims are processed. In these cases the answer to the question, “Does Medicare and my supplemental insurance work together?” is no. These policies are not technically Medicare supplement policies and they are not recognized by Medicare. No cooperative agreement exists between the two. Medicare patients covered by a regular insurer and Medicare should ensure that their claims are being submitted appropriately. If the policy was purchased to cover Medicare coinsurance and deductibles, patients may have to submit claims themselves for reimbursement if their physician does not offer this service.



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