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Recently, a client asked us to explain the rules around how much Medicare and carriers pay. They were surprised to hear from an employee that their carrier was not going to pay a claim unless the participant was enrolled in both Medicare Part A and Part B. Fortunately, the employee had reached out to the carrier prior to obtaining services and was able to avoid costly out-of-pocket expenses by enrolling in Medicare. We thought a refresher of the Medicare Secondary Payer rules might be in order. In addition, we will discuss how some of the carrier’s practices …

Medicare is a government program that provides health insurance for people 65 or older, people under age 65 with certain disabilities, and anyone with End-Stage Renal Disease (ESRD). It is administered by the Centers for Medicare and Medicaid Services (CMS), a division of the Department of Health and Human Services (HHS). Since 2006, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) prescription drug benefit (Medicare Part D, or Part D) allows all persons who are eligible for and enrolled in Medicare (due to age, disability or ESRD) to purchase Part D prescription drug coverage if they …