a person has medicare &insurance from wifes employment...what insurance provider is respon. for paying?

Question

husband has medicare/medicaid, also insured thru wives emply..who is responsible for paying, wifes insur. or medicaid

Answer 1

Always use private insurance when possible. Medicare and Medicaid can ask for a lien on your property.Your age also plays into determining whether they will try to get any money they spend on you back. I had this happen to me,any money they pay they will bill your private insurance. Always use your private insurance as primary.

Answer 2

Nurse Ratchet is closest to the correct answer. Federal law (known as TEFRA/DEFRA) states that, in the event that an employee or dependent is covered by a private health plan and Medicare, and the employer has less than 20 employees (Not just full-time or those enrolled in the group health plan), then Medicare is primary. If the employer has 20 or more employees, then the company's health plan is primary. This is not open to interpretation.

I am a bit confused with your reference to Medicaid. This is coverage that is funded by the Federal and State Government, but administered by the State for people who are income-eligible and have no other insurance coverage. I don't believe there is any benefit, and may in fact not be legal, to having all three. The Medicare, if Parts A and B, are sufficient to cover your husband.

Answer 3

The husband's insurance will be primary. If he has both Medicare and Medicaid, otherwise known as "dual eligible", he can get on a Medicare Advantage plan that might be more cost effective for him than also being on his wife's policy.

The dual eligible plans have no deductible and low co-pays. The premiums on dual eligible plans run from $0 to around $40 per month and medicaid will usually pick up that premium. Medicaid will also pick up any prescription drug coverage premium and will often pick up some if not all co-pays on both the Advantage plan and Drug plan.

You should go see an independent agent that works in the senior market. This person will know the plans that are available in your area and will be able to find the best fit for his situation. You may find that you'll be able to drop his coverage from the wife's employer and will be able to save a bunch of money.

Answer 4

If the group has less then 20 employees (usually the insurance companies say less then 20 on the health plan) then Medicare is primary. If there are more than 20 employees, then the health plan is primary. This is all governed by Federal law, but each insurance company interprets the laws differently sometimes regarding the "20 lives" guideline.

Answer 5

It depends a lot on if it is Medicare or Medicaid. The two are completely different. Either way, the wife's insurance would always be primary, then the Medicare or Medicaid would be secondary if the person was insured by a group insurance and a state funded insurance

Answer 6

Many variables.

*Is wife paying for husband coverage?
Probably paying too much and should just get a suppliment or Medicare Advantage.

*Does husband have medicare B?
IF one is employed (wife) with coverage AND on medicare then plan B is not required and the plan is primary. Husband doesn't qualify for this since he isn't employed so he should have both A & B (A is automatic at age 65, B is what you pay a premium for) and the work plan should probably be dropped. BUT check with the work plan provider.

Note: medicare plan C or medicare advantage (new name) takes the place of A&B so if he has that the comapny plan should also be dropped.

Bottom line for him Medicare is primary and the benefit from the company plan is probably not worth the cost.

Medicaid is the same as medicare with state administered assistance for low income people to pay medicare premiums and what medicare doesn't pay. Again the company plan would serve no purpose here or is too expensive for what it would provide.

The company plan may be paying for things medicare doesn't cover - dental, eyewear, etc. - again may not be worth the cost.

Answer 7

seems like the insurance should pay
medicare/medicaid is usually for people with no medical coverage

Answer 8

The HUSBAND'S policy is primary, the wife's policy is secondary. The secondary policy has the option of picking up any deductibles or copays (btw, there is a DIFFERENCE between Medicare and Medicaid!), but doesn't HAVE to pick up any MEDICARE copays or deductibles. When Medicare or Medicade hits their policy maximum payout ($100,000? $250,000?) THEN the wife's policy HAS to step in.

Answer 9

wife's insurance is first. medicare is next. medicaid last.