Coordination Of Benefits - Medicare Paying Nothing As Secondary Insurer

[Teresa Vuoso]

My husband has insurance through my employer. Medicare is secondary. He's been seeing MDs that are out-of-network with my insurance and my insurance pays a ridiculously low amount. I am certain that Medicare would pay significantly more on the claims if Medicare was his only insurance or was primary.

I submit the EOBs from the primary insurance with a claim form to Medicare and Medicare pays 0, zip, nada. The EOBs just say "you have other insurance that pays these claims." And then it says "the processing of your claims is not complete." The mymedicare.gov website shows all the claims and we never get any EOBs. All claims since 2015, the start of my employer's insurance coverage have the same two footnotes. And we never receive any EOBs from Medicare in the mail.

Has anyone else had this problem? Or have any suggestions.

 

[MBSC]

It is common for Part B to pay zero as secondary. This is why it is recommended to delay Part B enrollment when a decision is made to keep primary employer coverage on the spouse. The Part B premium is more than the secondary payments.

Checklist to determine if Medicare enrollment can be delayed: https://www.cms.gov/Outreach-and-Ed...ers-and-Unions/FS3-Enroll-in-Part-A-and-B.pdf

As explained on page 4, delaying Part B enrollment would have also delayed the Medigap "open enrollment period" in which you can buy a Medigap without answering health questions.

I can not explain why it says processing is not complete on the older claims. You may want to call Medicare to get more information.

 

[SMN]

If your husband is 65 I would highly suggest looking into a medicare supplemental plan, They can pick up all costs so you owe almost nothing out of pocket with a monthly premium. Then you no longer need to worry about group insurance issues.