Coordination of Medicare And Other Health Benefits

If you have Medicare and one or more other health care coverages and have a claim, Medicare and industry wide rules determine how costs are split between them. The rules answer such questions as:

• What if one health coverage includes the subject of the claim, but the other doesn't?
• Which health insurance pays first and which pays second?

Medicare speaks of this process as Medicare and "Other Health Benefits." The private sector calls it "Coordination of Benefits." To make the discussion in this article fit with the way people speak, we will call the process "Coordination of Benefits."

Coordination of benefits are intended to assure:

• That your medical bills are paid without conflict or delay.
• That the doctor or other health care provider only receives one payment.
• That you don't make a profit by seeking medical care.

The rules to determine which plan is primary and which plan is secondary depend on the type of coverage you have in addition to Medicare. The alternatives are:

• How Coordination Of Benefits Works  
• Group Health Insurance
  • 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  
  • Workers Compensation  
  • Veterans Benefits  
  • Champus  

If you have more than one health insurance coverage, and Medicare is not one of them, the rules are different. If this applies to you, click here.

NOTE: Bills to Medicare when there is more than one coverage are now sent to a national claims crossover contractor,  the Coordination of Benefits Contractor. This is instead of individual Medicare contractors.

If you still have questions after reading this article, call the Medicare number which answers coordination of benefit questions: 800.999.1118

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