Whom do I contact when there is a change in my other health insurance?

September 20, 2009 by admin

PRIMARY INSURANCE When you have Medicare and another insurance, there are times when the other insurance is primary to Medicare, meaning the other insurance pays first. Medicare has a dedicated "Coordination of Benefits Contractor" that keeps track of when Medicare is primary or when another insurer is primary. One common situation where your other health insurance may be primary to Medicare occurs when you have Medicare; are still working; and are covered by your employer's health insurance plan. Another is when you have Medicare, are retired, but your spouse is working and has a health plan that also covers you. If you are injured on the job, in an automobile accident, or slip and fall at a shopping center, often the cost of related medical care is covered by another insurer. You can contact the Coordination of Benefits Contractor at 1-800-999-1118 for questions about, or to report changes in, your primary insurance. SUPPLEMENTAL (Secondary) INSURANCE If you have other insurance and it pays after Medicare, it is called your supplemental insurance. Supplemental insurance often covers the deductible and/or co-payments required by Medicare. Examples include retiree insurance from your former employer or union, Medigap insurance, and Tricare for Life (for military retirees) and the Medicaid Program. If you change your supplemental insurance, or are experiencing problems with supplemental insurance payments, you need to call your old and new supplemental insurance companies. If you have questions about how your supplemental insurance works with Medicare, contact the supplemental insurer. If you need Medicare to start or stop sending claims information to a supplemental insurance company, again, this is something the supplemental insurer must resolve. Medicare does not keep any record of your supplemental insurance. If your supplemental insurance company has an agreement with Medicare, the process is as follows. Your supplemental insurance company periodically sends an electronic list of those it insures (who are also covered by Medicare) to Medicare-claims-processing contractors. This file is used to get copies of claims paid by Medicare. This helps the supplemental insurance company to automatically pay its share of your claim. This is why you need to contact your supplemental insurance company directly to ask it to update its records when you make changes in your supplemental insurance. Finally, if the problem seems to be related to claims from particular doctors or other providers, you should make sure that these providers have the right information on file about your supplemental insurance. It could be they are forwarding old, or inaccurate information on the claims they submit. The Medicare publication, Medicare and Other Health Benefits: Your Guide to Who Pays First contains additional information on this topic that you may find useful.