Medicare + other coverage (plan, hospital, doctor, Humana)

[phetaroi]

I'm wondering if this makes sense:

Medicare is my primary provider, and Aetna is my secondary coverage.

I have an elderly neighbor who swears her Humana coverage is primary and Medicare is secondary.

[jaminhealth]

As I understand it, when we opt for Medicare this is our primary...and if we want a supplement to pick up where medicare does not, then one buys a supplement.

Personally, I have Medicare only, no supplements and I pay copays to the so few doctors I see. For me I would be paying for a a supplement I wouldn't even use. I'm a lower income and don't want to sweat paying for a supplement which goes up each year or so. I have no clues but know it's a lot more pricey than when I started medicare 13 yrs ago.

[oldgardener]

It is different in various situations. You can read about Medicare coordination of benefits (who pays first in different situations) at this link. https://www.medicare.gov/Pubs/pdf/02179.pdf

[phetaroi]

Originally Posted by oldgardener

It is different in various situations. You can read about Medicare coordination of benefits (who pays first in different situations) at this link. https://www.medicare.gov/Pubs/pdf/02179.pdf

Interesting! Thank you so much for that!

[moved]

I have Blue Shield with Medicare as primary, and Molina with Medi-Cal as secondary. Molina pays anything that Blue Shield doesn't pay.

[Ariadne22]

Originally Posted by phetaroi

I have an elderly neighbor who swears her Humana coverage is primary and Medicare is secondary.

Your elderly neighbor probably has a Advantage plan - in which case all claims are submitted to and paid by Humana.

When one enrolls in an Advantage plan, one has effectively disenrolled from Original Medicare. The govt pays the Advantage plan a set fee each month per enrollee, providers submit claims to the Advantage plan, the Advantage plan pays for Medicare services. There is no interaction between the Medicare beneficiary and Medicare itself with Advantage enrollment.

If she does indeed have a Humana Medicare Supplement aka Medigap, then Medicare is primary, paying its 80%, w/Humana picking up the difference.

Doesn't sound like she has Medigap. Many elderly choose Advantage b/c it combines drugs and has zero or very low premium. The tradeoff is restricted provider networks, copays for docs and hospital, max out of pockets - and a lot more oversight on dispensation of benefits by Humana than she would experience with Original Medicare b/c anything Humana pays out affects it bottom-line profits.