How Do You Determine If Medicare is Primary or Secondary?





If a retiree has Medicare as his insurance and has another insurance plan, he probably wonders how he can determine if the government-sponsored program is primarily responsible for his health care coverage or if it is his secondary coverage. A recipient should answer this question before making his first doctor’s appointment. Declaring Medicare as primary or secondary does make a difference in the number of doctors that a patient can see.

It’s Easy If a Recipient Has a Medigap Plan

If a retiree has a Medigap plan, it means that Medicare will be his primary insurance plan. As with any other supplemental insurance policy, Medigap plans exist to cover items that Medicare does not pay. The premiums are usually reasonable, but Medigap plans are not always needed.

Is Medicare Primary or Secondary if I Have Other Health Insurance?

Whether Medicare is primary or secondary payer depends on the coverage a person has with a primary insurance company. The insurance company that pays more money per claims will probably be the one that the doctor’s office bills first. Declining Medicare payments have made many doctors cautious about taking new patients with Medicare.

Medicare Primary or Secondary Can Change

Basically, it comes down to how a particular doctor’s office is set up and the level of coverage. Some doctors do not accept Medicare patients unless they use Medicare as the secondary payer. When a patient visits a new doctor for the first time, an office staff member will ask him or her if she wants to make Medicare the primary or secondary payer. Sometimes, the office may not give the client a choice. The best thing to do is to find out before making a doctor’s appointment. Although doctor’s may subscribe to high ideals, a doctor’s office, is, at its core, still a business and must turn a profit.



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