In a few cases, Medicare-eligible individuals can have more than one health insurance but which insurance would be considered Primary (the first payer of benefits) and which would be secondary (the second payer of benefits)? Medigap insurance supplements Original Medicare so it is almost always the secondary payer to Medicare. See below for a detailed explanation and the one exception where Medigap can be considered the “primary” payer.
Overview of Medicare Eligible Primary and Secondary Insurance
Medigap, also known as Medicare Supplement Insurance (or Med Supp), can play a crucial role in covering healthcare expenses for Medicare beneficiaries. But can it be your primary coverage? The answer is usually NO.
Medigap plans are designed to work alongside Original Medicare (Part A and Part B). They help fill the gaps in coverage by covering expenses such as deductibles, copayments, and coinsurance. In this context, Medigap acts as secondary coverage, complementing Original Medicare’s primary role. (Source)
If you are on a health insurance plan through work and also have Medicare, it is not so clear which will be the primary and which will be the secondary payer for medical claims. Often times it depends on the size of the company that is offering you work-related insurance. Check out Medicare.gov’s coordination of benefits article for a detailed explanation about primary and secondary coverage when you have coverage through work, COBRA, or VA coverage.
Original Medicare Is Usually the Primary Payer with Medigap
Unless you have additional insurance through work, Original Medicare is usually considered primary insurance for those on Medicare. Medicare covers a broad range of healthcare services, including hospital stays (Part A) and medical services (Part B).
If you have both Original Medicare and a Medigap policy, Original Medicare remains your primary insurance, while Medigap pays secondary and helps cover the out-of-pocket costs. Learn more about What Medigap Covers using this link. In almost every case, Medicare pays expenses first then if you have Medigap would help pay those (secondary) costs not already paid by Medicare. For example, If you had a MedSupp plan F and you saw a doctor, Medicare would pay 80% (primary payer) and Medigap would pay 20% (secondary) payer.
When Medigap Can Be Primary
As far as we are aware, there is only one circumstance where Medigap would be considered the primary payer: Foreign Travel Emergency Coverage. Since Medicare has no coverage for foreign travel emergencies, Medigap will pay 80% when you need health care abroad and you become the “secondary” payer by paying the remaining 20%. Medicare will pay 0%.
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Medigap policies are standardized by the federal government, meaning they offer the same basic benefits regardless of the insurance company you choose. However, prices can vary significantly between providers. It’s essential to explore different Medigap plans and compare rates to find the coverage that best meets your needs and budget. You can visit our wizard to assist you with that.
Select a MedSup plan that suits your needs and provides the necessary financial protection. You can get an instant quote here, or just call us at 800-930-7956.
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