Medicare Primary Option includes medical coverage through the Aetna Medicare Plan (PPO) with Extended Service Area (ESA) and prescription drug coverage through Express Scripts Pharmacy. Aetna Medicare is a HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal.
Full Answer
What does it mean when Aetna is secondary Medicare?
Sep 13, 2021 · When you’re dual eligible for both Medicare and Medicaid, Medicare is your primary payer. Medicaid will not pay until Medicare pays first. Medicaid will not pay until Medicare pays first. 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.
Does Aetna have Medicare Advantage plans?
Sep 26, 2010 · The answer depends on what type of Aetna Medicare Plan you have. If you have an Aetna Medicare Supplemental Plan, then Original Medicare pays first and the Aetna plan pays secondary If you have an...
What kind of doctors do Aetna Medicare Advantage patients have to see?
How Medicare works with other insurance. and other health insurance (like from a group health plan, retiree coverage, or Medicaid), each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decide who pays first. The "primary payer" pays what it owes on your bills first, and then sends the ...
Does Aetna have out-of-pocket health care providers?
We will inform you if the patient is covered and which plan is primary. Log in to submit an electronic COB claim. Commercial insurance claims in which another payer is primary and Aetna is secondary. Medicare primary claims for which Medicare* has not already forwarded their claims and payment information to us.
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 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 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 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 a group health plan?
If the. group health plan. In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families.
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 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).
What to do when Aetna is secondary?
When Aetna is secondary, you will need to include the appropriate code on your claim that tells us information about the primary payer’s payment. Contact the practice management support team and/or the clearinghouse you use to submit your electronic claims.
What is the EOP code for Medicare?
If the Medicare electronic remittance advice (ERA) or Explanation of Payment (EOP) contains an "MA 18" or "N89" remark code, the Medicare carrier has automatically sent us your claim. In these cases, you don't have to send us a Medicare primary COB claim.
Is Aetna a part of CVS?
and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Aetna is proud to be part of the CV S Health family . You are now being directed to the CVS Health site.
Is Aetna responsible for the content of linked sites?
Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Continue. You are now being directed to the US Department of Health and Human Services site.
When a patient comes to you, can you submit an eligibility and benefits inquiry?
When a patient comes to you, you can submit an eligibility and benefits inquiry. We will inform you if the patient is covered and which plan is primary. Medicare primary claims for which Medicare* has not already forwarded their claims and payment information to us.
Is Aetna liable for non-Aetna sites?
You are now leaving the Aetna website. Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Continue.
Why is Aetna fee higher than Medicare?
The fees for health services may be higher. This is because Aetna providers agree to accept a certain amount for your care. For example, if you usually pay 20% of the Medicare-approved cost for in-network care, you may be responsible for up to 50% of the cost for out-of-network care.
How to contact Aetna Medicare?
If you have any questions about your Aetna Medicare Advantage plan or how to find Aetna network providers, you can contact Aetna Customer Service at 1-800-282-5366 (TTY: 711), 8 a.m. to 8 p.m., local time, seven days a week, from October 1 – February 14 and 8 a.m. to 8 p.m., local time, Monday – Friday, from February 15 – September 30.
How does Aetna work?
If you’re enrolled in a Medicare Advantage plan through Aetna, and you choose to use a provider outside your plan’s provider network, one or more of the following things may happen: 1 Your plan may pay less toward your care. Some plans do cover certain out-of-network services, while others pay nothing for non-emergency care outside the network. 2 The fees for health services may be higher. This is because Aetna providers agree to accept a certain amount for your care. For example, if you usually pay 20% of the Medicare-approved cost for in-network care, you may be responsible for up to 50% of the cost for out-of-network care. 3 Any amount you pay might not contribute to your plan deductible, if you have one. 4 You may need preauthorization for any services you receive in order for any coverage to apply.
How to find contracted Aetna?
The easiest way to find contracted Aetna providers is to use Aetna’s online Medicare Advantage . You simply enter your location (zip code) and the type of medical provider you are looking for, and the tool lists Aetna’s Medicare providers in your area. You can also use Aetna’s provider search tool to find health-care facilities, pharmacists, ...
Does Aetna have Medicare Advantage?
Aetna’s Medicare Advantage providers include primary care doctors, specialists, hospitals, surgical centers, laboratories, imaging centers, dentists, pharmacists, and other health-care professionals. Aetna’s network providers have agreed under contract to provide care for its members, usually at lower rates than they would otherwise charge you ...
Does Aetna pay for out of network care?
Depending on the plan you choose, you may be required to get all your care from providers in your Aetna Medicare Advantage plan network; you may have to pay in full (other than emergency treatment) for out-of-network care.
Does Medicare cover out of network services?
If you’re enrolled in a Medicare Advantage plan through Aetna, and you choose to use a provider outside your plan’s provider network, one or more of the following things may happen: Your plan may pay less toward your care. Some plans do cover certain out-of-network services, while others pay nothing for non-emergency care outside the network.
What does it mean when Medicare is primary?
When Medicare is Primary. Primary insurance means that it pays first for any healthcare services you receive. In most cases, the secondary insurance won’t pay unless the primary insurance has first paid its share. There are a number of situations when Medicare is primary.
What is secondary insurance?
Secondary insurance pays after your primary insurance. It serves to pick up costs that the primary coverage didn’t cover. For example, if your primary insurance has a $1000 deductible, but your secondary insurance has a $500 deductible, your secondary would kick in to pay $500 of that $1000 bill.
What is the term for a former employer providing health insurance for you after you are no longer working?
You Have Retiree Coverage or COBRA. Sometimes a former employer provides group health insurance coverage for you AFTER you are no longer working. This is called retiree coverage. Medicare is primary and your providers must submit claims to Medicare first. Your retiree coverage through your employer will pay secondary.
What is tricare for life?
You Have Tricare-for-Life. Tricare-for-Life (TFL) is for military retirees and their spouses who are also eligible for Medicare. In this scenario, Medicare is the primary insurance for any care you receive at non-military providers, so you need to enroll in both Part A and B.
When does Medicare end for ESRD?
You would then re-enroll when you turn 65. Typically Medicare due to ESRD will end 36 months after you’ve had your kidney transplant unless you also qualify for Medicare due to age or other disability.
Does Medicare expect you to know who is primary?
Medicare Expects YOU to Know Who is Primary. In our example above, Patricia didn’t realize that since her employer has less than 20 employees, Medicare would be her primary coverage. By failing to enroll in Medicare, she was now responsible for paying for the cost of that MRI.
Is Medicare primary or secondary?
Then of course there is employer coverage. If you have active employer coverage, whether Medicare is primary or secondary also depends on the size of the insurance company.