Medicare Supplement Plans

What is a Medicare Supplement plan and how does it work?

A Medicare Supplement Plan is a health benefits coverage plan that complements (or supplements) your regular Medicare coverage.

Although Medicare pays for many health care services and supplies, it doesn’t pay for all of them. A Medicare Supplement Plan will help pay for those costs which could include deductibles, coinsurance and copayments when visiting your doctor. An Anthem Medicare Supplemental Plan is also a good idea if you prefer to keep your own doctor and hospital and choose your own specialist and other health care provider.

What are the costs? You’ll be responsible for a premium each month. There are also some out-of-pocket fees, depending on the plan you choose.

Who is eligible? You are eligible for a Medicare Supplement Plan if you are enrolled in Medicare Parts A and B and if you are age 65 or older or, in some states, under age 65 with a disability and/or end stage renal disease (plan offerings and eligibility vary by state). You also must be a resident of the state where the policy is offered.

How do I choose a Medicare Supplement Plan? The best way to choose is by comparing the coverage and rates. You can do this by selecting your state below for plan details and benefits.

How Medicare works with other insurance:

If you have Medicare and other health insurance or coverage, each type of coverage is called a “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” to pay. In some cases, there may also be a third payer.

What does it mean to pay primary/secondary?

  • 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.
  • If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.

Paying “first” means paying the whole bill up to the limits of the coverage. It doesn’t always mean the primary payer pays first in time. 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’ve made. If you have questions about who pays first, or if your insurance changes, call the Medicare Coordination of Benefits Contractor.

Note: Tell your doctor and other health care providers if you have coverage in addition to Medicare. This will help them send your bills to the correct payer to avoid delays.

What’s a conditional payment?

A conditional payment is a payment Medicare makes for services another payer may be responsible for. Medicare makes this conditional payment so you won’t have to use your own money to pay the bill. The payment is “conditional” because it must be repaid to Medicare when a settlement, judgment, award, or other payment is made.

If Medicare makes a conditional payment for an item or service, and you get a settlement, judgment, award, or other payment for that item or service from an insurance company later, the conditional payment must be repaid to Medicare. You’re responsible for making sure Medicare gets repaid for the conditional payment.


How Medicare recovers conditional payments

If Medicare makes a conditional payment, you or your representative should call the Medicare Coordination of Benefits Contractor (COBC).

The COBC will notify the recovery contractor to work on your case. The recovery contractor is a separate contractor who uses the information you or your representative gives to the COBC to see Medicare gets repaid for the conditional payments.

The recovery contractor will gather information about any conditional payments Medicare made related to your pending settlement, judgment, or award. Once a settlement, judgment, or award is final, you or your representative should call the recovery contractor. The recovery contractor will get the final repayment amount (if any) on your case and issue a letter requesting repayment.