Usually if you’re retired, Medicare is primary. If you’re still actively working, we’re your primary coverage. Throughout this booklet, we’ll talk about your benefits if Medicare is primary (unless otherwise noted). If you want to know about benefits when Medicare is secondary, you can view our brochures at fepblue.org/brochure.
What does Blue Shield 65 plus cover?
You permanently reside in the Blue Shield 65 Plus service area Blue Shield 65 Plus offers: Low or no copayments on many services such as doctors visits and hospital stays Routine chiropractic and routine hearing coverage Health management programs, health education, and wellness resources SilverSneakers Fitness Program – at no extra cost!
Are you dual-eligible for Medicare benefits?
If you’re dual-eligible and need assistance covering the costs of Part B and Part D, you could qualify for a Medicare Savings Program to assist you with these costs. Always make sure your provider accepts both Medicare and Medicare before seeking care.
How does retiree coverage work with Medicare Part A and B?
Retiree coverage might not pay your medical costs during any period in which you were eligible for Medicare but didn't sign up for it. When you become eligible for Medicare, you will need to enroll in both Medicare Part A and Part B to get full benefits from your retiree coverage. How does your retiree coverage work with Medicare?
Is Blue Cross and blue shield good for retirees?
together for you. The Blue Cross and Blue Shield Service Benefit Plan is the number one choice of federal retirees in the Federal Employees Health Benefits Program. For 60 years, we’ve been covering federal employees and retirees.
How do you determine which health insurance is primary?
Primary insurance is a health insurance plan that covers a person as an employee, subscriber, or member. Primary insurance is billed first when you receive health care. For example, health insurance you receive through your employer is typically your primary insurance.
Does Medicare automatically become primary at 65?
I dropped employer-offered coverage. If you're 65 or older, Medicare pays first unless both of these apply: You have coverage through an employed spouse. Your spouse's employer has at least 20 employees.
Is Medicare automatically primary?
Medicare is always primary if it's your only form of coverage. When you introduce another form of coverage into the picture, there's predetermined coordination of benefits. The coordination of benefits will determine what form of coverage is primary and what form of coverage is secondary.
Is Medicare primary or secondary payer?
Your workers' compensation insurance will be primary for any services or items related to your workers' compensation claim. Medicare will serve as your primary service for all covered medical expenses unrelated to that claim.
How do I know if my Medicare is primary or secondary?
Medicare pays first and your group health plan (retiree) coverage pays second . If the employer has 100 or more employees, then the large group health plan pays first, and Medicare pays second .
What determines primary and secondary insurance?
Primary insurance: the insurance that pays first is your “primary” insurance, and this plan will pay up to coverage limits. You may owe cost sharing. Secondary insurance: once your primary insurance has paid its share, the remaining bill goes to your “secondary” insurance, if you have more than one health plan.
Does Medicare automatically forward claims to secondary insurance?
If a Medicare member has secondary insurance coverage through one of our plans (such as the Federal Employee Program, Medex, a group policy, or coverage through a vendor), Medicare generally forwards claims to us for processing.
Will Medicare pay my primary insurance deductible?
“Medicare pays secondary to other insurance (including paying in the deductible) in situations where the other insurance is primary to Medicare.
Can you have Medicare and employer insurance at the same time?
Yes, you can have both Medicare and employer-provided health insurance. In most cases, you will become eligible for Medicare coverage when you turn 65, even if you are still working and enrolled in your employer's health plan.
When a patient is covered through Medicare and Medicaid which coverage is primary?
Medicaid can provide secondary insurance: For services covered by Medicare and Medicaid (such as doctors' visits, hospital care, home care, and skilled nursing facility care), Medicare is the primary payer. Medicaid is the payer of last resort, meaning it always pays last.
Is it necessary to have supplemental insurance with Medicare?
For many low-income Medicare beneficiaries, there's no need for private supplemental coverage. Only 19% of Original Medicare beneficiaries have no supplemental coverage. Supplemental coverage can help prevent major expenses.
Does secondary insurance cover primary deductible?
Does secondary insurance cover the primary deductible? Typically not. If you have a deductible on one or both plans, you will need to pay those deductibles before your insurance reimburses you for care.
How does Medicare work with my job-based health insurance when I stop working?
Once you stop working, Medicare will pay first and any retiree coverage or supplemental coverage that works with Medicare will pay second.
When & how do I sign up for Medicare?
You can sign up anytime while you (or your spouse) are still working and you have health insurance through that employer. You also have 8 months after you (or your spouse) stop working to sign up.
Do I need to get Medicare drug coverage (Part D)?
Prescription drug coverage that provides the same value to Medicare Part D. It could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, VA, or individual health insurance coverage.
How does Medicare work with other insurance?
When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" (supplemental payer) ...
What is the phone number for Medicare?
It may include the rules about who pays first. You can also call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY: 1-855-797-2627).
How long does it take for Medicare to pay a claim?
If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should have made. If Medicare makes a. conditional payment.
What is the difference between primary and secondary insurance?
The insurance that pays first (primary payer) pays up to the limits of its coverage. The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover. The secondary payer (which may be Medicare) may not pay all the uncovered costs.
How many employees does a spouse have to have to be on Medicare?
Your spouse’s employer must have 20 or more employees, unless the employer has less than 20 employees, but is part of a multi-employer plan or multiple employer plan. If the group health plan didn’t pay all of your bill, the doctor or health care provider should send the bill to Medicare for secondary payment.
When does Medicare pay for COBRA?
When you’re eligible for or entitled to Medicare due to End-Stage Renal Disease (ESRD), during a coordination period of up to 30 months, COBRA pays first. Medicare pays second, to the extent COBRA coverage overlaps the first 30 months of Medicare eligibility or entitlement based on ESRD.
What happens when there is more than one payer?
When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" (supplemental payer) to pay. In some rare cases, there may also be a third payer.
What happens when you retire from Medicare?
Understanding Your Medicare Benefits. When retirement finally comes, it may bring changes into your life. While you may enjoy some time to travel or spend time with family, you may find changes when it comes to your health insurance as well.
When do you have to sign up for Medicare?
It is important to sign up for Medicare as soon as the eligibility period opens, which occurs three months prior to your 65th birthday. It will apply during the month of your 65 th birthday, and three months after your birthday.
What is Medicare Part C?
Medicare Part C is also known as Medicare Advantage, and these plans are provided through private insurance companies. They include the same benefits as Part A and B, but they may also provide benefits for prescription drug coverage and additional services, such as dental, vision, and hearing.
What is original Medicare?
Original Medicare is the federal program available to all individuals eligible for Medicare. It includes Part A and Part B. Medicare Part A and Part B can both be selected upon enrollment, or Part B can be declined if a person so chooses.
What is Part B insurance?
Part B covers outpatient expenses and preventive care, such as annual checkups, diagnostic testing, ambulance services, and studies. Part B requires a monthly premium payment and can be declined upon eligibility.
What is Medicare for seniors?
What's Medicare? Medicare is a federal health insurance program for people age 65 or older, people under 65 who have certain disabilities and people of any age who have End-Stage Renal Disease. It has four parts that cover different healthcare services.
How does Medicare work with service benefit plan?
Combine your coverage to get more. Together, the Service Benefit Plan and Medicare can protect you from the high cost of medical care . Medicare works best with our coverage when Medicare Part A and Part B are your primary coverage. That means Medicare pays for your service first, and then we pay our portion.
How much does Medicare reimburse for a B plan?
Each member of a Basic Option plan who has Medicare Part A and Part B can get reimbursed up to $800 per year for paying their Medicare Part B premiums.
What is the eligibility for Blue Shield 65 Plus?
To be eligible to enroll in Blue Shield 65 Plus SM (HMO) Plan, you must meet the following criteria: You are retired. You have Medicare Part A and Part B. You permanently reside in the Blue Shield 65 Plus service area. Blue Shield 65 Plus offers: Access to a broad range of network providers. Comprehensive benefits and coverage.
How to find a primary care physician for Blue Shield 65?
To find a Blue Shield 65 Plus primary care physician, search for a Blue Shield 65 Plus Group physician, click on Advanced Search, then type "HMO Personal Physicians" in the box under "Doctor Type or Specialty". If you need to change your primary care physician, just call Blue Shield 65 Plus Member Services at (800) 776-4466.
How to contact LifeReferrals?
Just call (800) 985-2405 anytime. The LifeReferrals 24/7 SM phone number is also located on the back of your member ID card. SilverSneakers® Fitness Program – As a Blue Shield 65 Plus member, you have access to the SilverSneakers Fitness Program at no additional cost to you.
Where can I refill my Blue Shield 65 Plus prescription?
As a Blue Shield 65 Plus member, you can fill or refill your prescription drugs at a Blue Shield 65 Plus network pharmacy or use the convenient mail service pharmacy. Network pharmacies are conveniently located in many areas and include retail chains such as Walgreens, Rite Aid, CVS, and more. For assistance in finding a network pharmacy ...
Do you need an ID for Blue Shield 65 Plus?
Additionally, with Blue Shield 65 Plus you will only need one ID card to access healthcare services from a network of local doctors, specialists, and hospitals and be able to fill prescriptions at a broad network of pharmacies. There's less paperwork for you, because we do all the coordination with Medicare. Selecting a primary care physician: When ...
Is Blue Shield California an HMO?
Blue Shield of California is an HMO plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal. Blue Shield 65 Plus offers individual and employer group retiree plans to Medicare beneficiaries who have Part A and Part B. Individual plans are open to all Medicare beneficiaries who reside within ...
How to learn more about Medicare?
How to Learn More About Your Medicare Options. Primary insurance isn't too hard to understand; it's just knowing which insurance pays the claim first. Medical billing personnel can always help you figure it out if you're having trouble. While it's not hard to understand primary insurance, Medicare is its own beast.
Is Medicare primary insurance in 2021?
Updated on July 13, 2021. Many beneficiaries wonder if Medicare is primary insurance. But, the answer depends on several factors. While there are times when Medicare becomes secondary insurance, for the most part, it’s primary. Let’s go into further detail about what “primary” means, and when it applies.
Is Medicare a primary or secondary insurance?
Mostly, Medicare is primary. The primary insurer is the one that pays the claim first, whereas the secondary insurer pays second. With a Medigap policy, the supplement is secondary. Medicare pays claims first, and then Medigap pays. But, depending on the other policy, you have Medicare could be a secondary payer.
Does Medicare pay your claims?
Since the Advantage company pays the claims, that plan is primary. Please note that Medicare WON’T pay your claims when you have an Advantage plan. Medicare doesn’t become secondary to an Advantage plan. So, you’ll rely on the Advantage plan for claim approvals.
Can you use Medicare at a VA hospital?
Medicare and Veterans benefits don’t work together; both are primary. When you go to a VA hospital, Veteran benefits are primary. Then, if you go to a civilian doctor or hospital, Medicare is primary. But, you CAN’T use Veterans benefits at a civilian doctor. Also, you can’t use Medicare benefits at the VA.
Is Medicare a part of tricare?
Medicare is primary to TRICARE. If you have Part A, you need Part B to remain eligible for TRICARE. But, Part D isn’t a requirement. Also, TRICARE covers your prescriptions. Your TRICARE will be similar to a Medigap plan; it covers deductibles and coinsurances.
What is the difference between Medicare and Medicaid?
Eligible for Medicare. Medicare. Medicaid ( payer of last resort) 1 Liability insurance only pays on liability-related medical claims. 2 VA benefits and Medicare do not work together. Medicare does not pay for any care provided at a VA facility, and VA benefits typically do not work outside VA facilities.
Is Medicare a secondary insurance?
When you have Medicare and another type of insurance, Medicare is either your primary or secondary insurer. Use the table below to learn how Medicare coordinates with other insurances. Go Back. Type of Insurance. Conditions.
How to contact Blue Shield of California?
Call (800) 776-4466 .
What is TRICARE for life?
TRICARE for Life (TFL) is given to TRICARE-eligible individuals who carry Medicare Parts A and B. TFL benefits cover your Medicare deductible and coinsurance.
Does Medicare pay for spouse?
Coverage from your spouse’s employer and Medicare: If your spouse’s employer has fewer than 20 employees, Medicare pays first. If it's a larger company, the business's health plan pays first. After both insurers pay, you pay the balance.
Can you keep Medicare if you have California?
There is usually no reason to keep an individual or Covered California plan once you have Medicare. It is illegal for someone to sell you a marketplace or individual market policy. You are not eligible for tax credits or other savings, which means you would pay full price for a marketplace plan.
Is Medicare primary or secondary?
Employer coverage and Medicare: If you work for a company with fewer than 20 employees, Medicare is considered your primary coverage. That means Medicare pays first, and your employer coverage pays second. If you work for a larger company, your employer-based coverage will be your primary coverage and Medicare your secondary coverage.
Does Medicare cover VA doctor visits?
Medicare covers your civilian doctor visits, and the VA covers your visits to VA facilities. Medicare may pay part of your copayment ...
How much is Part B premium?
For you and your husband, a year of Part B premiums adds up to $2,770, meaning that if you wait a year before signing up, your premiums will be $277 a year more than they would have been otherwise. Choice 2. Take both Part B and your FEHB plan.
Do you have to take Part B if you are retired?
You are in a position that many retirees would kill for, but you still have decisions to make. While most retirees must take Part B once they or their spouse are no longer actively employed, such is not the case for federal retirees. You basically have three choices, all with pros and cons.
Is FEHB a Medigap?
This will be more expensive because you will be paying two sets of premiums, but your FEHB plan will now function as a Medigap plan for both your hospital and doctor bills, and cover your drugs as it always did.