When you're married, each of you have responsibilities that you take on based on your mutual agreement. You act as one unit but you each take on different tasks to make things run smoothly. When you're dating, each of you live separate lives. You may assist the person you are dating with something but you're not living blended lives, you're not one unit. There are things you simply cannot do for the other person.
Medicare and your Medigap plan are just dating - they are two separate coverages. The Medigap cannot take over and pay for services if they are not first covered by Medicare A and/or B. If you receive a service that is not a Medicare-covered service, your Medigap will not pay any portion of the bill. Now, if you weren't told in advance that the service you were receiving was not covered by Medicare, then most likely the cause of non-payment was incorrect coding which can be corrected by the provider and then resubmitted to Medicare for payment and submission to your Medigap carrier. There are only two exceptions to that rule - Part B excess charges and emergency medical services received outside of the U.S. In those two instances, Medicare will not pay those charges, but your Medigap may - depending on which plan you have chosen.
What about my Medicare Advantage plan you ask? That's a marriage. Medicare Advantage plans are replacing your Original Medicare benefits because you've assigned your benefits to the plan. They are joined as one. Spouse #1 (Original Medicare) makes deposits (in the form of premiums) into the account of Spouse #2 (the Medicare Advantage Plan) and Spouse #2 handles the payment of the bills (your claims). Any claims sent to Original Medicare will be denied and deferred to your Medicare Advantage plan because it has taken on that responsibility via a contract (mutual agreement) with Original Medicare.
If you have any questions about this or any other retirement planning topic, give us a call at 602-281-3898 so we can help make your retirement 123Easy!
By American Retirement Advisors
American Retirement Advisors helps retirees and pre-retirees navigate Medicare, estate planning, and retirement income — so you can enjoy the retirement you've earned.
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Easy Eddie's Take
The dating versus marriage analogy really helps explain something that confuses a lot of people. Here's the good news: once you understand how these relationships work, Medicare billing makes a lot more sense. With Original Medicare plus a Medigap supplement plan (Plans A through N), Medicare Part A and Part B process your claim first, then automatically send the remaining balance to your Medigap insurer. You don't have to do anything.
Most people are surprised when they learn that Medicare Advantage plans are completely different. When you enroll in a Medicare Advantage plan through companies like Humana, UnitedHealthcare, or Aetna, you're essentially telling the Centers for Medicare & Medicaid Services to redirect your Medicare benefits to that private plan. That's why you get one insurance card instead of separate Medicare and Medigap cards.
One question that comes up all the time is whether you can switch between these options. During Medicare Annual Open Enrollment (October 15 through December 7 each year), you can move from Medicare Advantage back to Original Medicare, but getting a new Medigap plan might require medical underwriting depending on your state. A little planning ahead can save you a lot of confusion later.