Content Overview
- Overview
- How Coordination Of Benefits Works
- Medicare And Group Health Insurance
- Medicare and Group Health Insurance: People Age 65 or Over
- Medicare and Group Health Insurance: People Who Are Disabled (Not Due To End Stage Renal Disease or ALS) AND Under Age 65
- Medicare and Group Health Insurance: People Disabled With End Stage Kidney Disease (ESRD) Or With ALS
- Medicare and Group Health Insurance: If You Have Been Disabled And Return To Work
- Medicare and Group Health Insurance: Medicare and More Than One Group Policy
- Medicare And Individual Health Insurance
- Medicare And Workers Compensation
- Medicare And Veterans Benefits
- Medicare And Champus
Coordination of Medicare And Other Health Benefits
Medicare And Individual Health Insurance
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Medicare ignores any benefits paid by an individual health insurance policy. However, that doesn't mean that both plans pay their full benefits.
Virtually all individual health insurance policies contain a provision that limits the insurance company's payments to their regular payment less any payments made by Medicare. Such a provision means that Medicare and your health insurance together will pay no more than your individual health insurance would have paid if it were the only insurance. In other words, the individual insurance company, not you or your doctor, gets the benefit of Medicare paying a portion of the bill.
Example: You have an individual health plan and Medicare. The individual health plan contains a provision that limits the insurance company's payment to their regular payment less any payments made by Medicare. The health plan would have paid $4,000 if there had been no other insurance, but Medicare pays $2,800 towards the bill. The insurance company will subtract Medicare's payment from their regular payment and pay the difference, in this case, $1,200 ($4,000 - $2,800).
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