If you have more than one type of health insurance (say, Medicare and an employer plan or retiree coverage), knowing who pays first can be confusing. To help you fully understand, this Medicare Supplement broker in Northwest Indiana is going to explain how Medicare coordinates benefits with other types of insurance.

Learn about the coordination of benefits.

“Coordination of benefits” is the system that decides which plan pays first when you have more than one. The order depends on factors like your age, employment status, whether you are receiving disability benefits, and even the size of your employer.

For example, if you are 65 or older and still working for a company with 20 or more employees, your employer’s group health plan usually pays first, and Medicare pays second. But if that company has fewer than 20 employees, Medicare pays first.

These rules can be confusing, which is why you should reach out to your local Medicare Supplement broker in Northwest Indiana. They will make sure that your claims are filed correctly and that you are not left waiting for payments that should have been processed weeks ago.

Who pays first in different situations?

If you have retiree coverage, Medicare almost always takes the lead. Retiree plans are considered secondary and will cover what Medicare does not. Once you reach 65, Medicare becomes the primary payer.

If you are on COBRA, the same rule applies. Medicare pays first once you are eligible.

If you qualify for Medicare due to a disability, your employer size will once again become a factor. If your company has 100 or more employees, your employer plan pays first. Fewer than 100, and Medicare will take the primary spot.

For people with End-Stage Renal Disease (ESRD), their employer or union plan pays first during the first 30 months of coverage. Medicare becomes the primary payer after that period ends.

What if you also have Medicaid? Well, Medicaid always pays last. So, in your case, Medicare pays first, and then Medicaid will cover the remaining costs.

Medicare coverage trends in Northwest Indiana.

In Northwest Indiana, questions about who pays first come up all the time. After all, nearly one in five residents in our region is now 65 or older. Many are still working part-time or are covered under a spouse’s plan. That mix of coverages can create confusion about who pays what.

Employers around Lake, Porter, and LaPorte counties range from small family-owned shops to large healthcare systems. That is important because Medicare’s coordination rules depend on employer size.

Your local Medicare Supplement broker in Northwest Indiana understands how those employer setups look here. They can help you learn which rules specifically apply to your situation.

How does Indiana handle these coverage rules?

Indiana generally follows the same federal rules as the rest of the country when it comes to how Medicare coordinates benefits. But the state does have its own regulations that shape how private insurance handles things behind the scenes.

For example, the Indiana Administrative Code (760 IAC 1-38.1) shows how private group plans decide who pays first when Medicare is not involved. It is not something most people ever read, but it helps keep everyone on the same page about how claims are handled.

When Medicare is part of the equation, federal law wins out. Still, Indiana’s insurance regulators make sure that local companies are operating within the rules and coordinating correctly with Medicare’s payment orders.

On top of that, a new state law (Senate Enrolled Act 215) gives people under 65 with Medicare a guaranteed right to buy a Medigap plan. Before this, finding supplemental coverage could be tough if you were under 65. Now, it has become much easier for Northwest Indiana residents who juggle multiple coverages to add a supplemental policy when Medicare becomes their primary coverage.

Looking for a Medicare Supplement Broker in Northwest Indiana?

If you would like to learn more about your Medigap coverage and who pays first, do not hesitate to reach out to your local Medicare Supplement broker in Northwest Indiana — like Senior Care Insurance Services. We work with top-rated Medicare Supplement companies and can guide you every step of the process. Contact us today to schedule a free consultation.