You are here: Home Government ... Medicare 101: An ... Coordination of ... Medicare And Individual ...
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Coordination of Medicare And Other Health Benefits

Medicare And Individual Health Insurance

Next » « Previous


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).

Please share how this information is useful to you. 0 Comments


Post a Comment Have something to add to this topic? Contact Us.

Characters remaining:

  • Allowed markup: <a> <i> <b> <em> <u> <s> <strong> <code> <pre> <p>
    All other tags will be stripped.