Mrs. Evans has just become eligible for Medicare. However, she also has a supplemental policy through Anthem and would like to better understand who pays what. Since she has an appointment next week for her annual physical, she has called to get more information about this new insurance.
Explain how Medicare and supplemental policies are billed. Which is primary? What if the primary does not pay the entire claim?
Expert Solution Preview
Introduction:
In the field of medical education, it is important for students to understand the complexities of medical insurance and how it impacts patient care. One common issue that arises is determining how Medicare and supplemental policies are billed. In this answer, we will discuss which insurance is primary and what happens when the primary insurance does not cover the full cost of care.
Answer:
Medicare is considered the primary insurance for individuals aged 65 and older or those with certain disabilities. The supplemental policy is secondary and kicks in to cover any additional costs not covered by Medicare. When a patient receives medical care, the health care provider will bill Medicare first, and then the supplemental policy for any remaining costs.
If the primary insurance, in this case, Medicare, does not pay the entire claim, then the secondary insurance may cover the remaining cost. However, this is dependent on the specific policies, and some secondary insurances have a limit on the amount they will cover.
In the case of Mrs. Evans, Medicare will be billed first for her annual physical, and any remaining costs will then be billed to her supplemental policy through Anthem. It is important for patients to understand their specific insurance policies and what is covered to prevent any unexpected costs.
