JLSMITH EDUCATION CENTER

Taking the guesswork out of your plan!

What is a primary payer?

June 11, 2017

 

If a Medicare Beneficiary has Medicare and other health insurance or coverage, each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on their bills first, and then sends the rest to the "secondary payer" to pay. In some cases, there may also be a third payer.

What do primary and secondary payers pay on a bill?

  • The insurance that pays first referred to as the (primary payer) pays up to the limits of its coverage.

  • The insurance that pays second referred to as the (secondary payer) only pays if there are costs the primary insurer didn't cover.

  • The secondary payer (which may be Medicare) may not pay all the uncovered costs.

  • If their employer insurance is the secondary payer, they may need to enroll in Medicare Part B before their insurance will pay.

If the insurance company doesn't pay the claim promptly (usually within 120 days), their doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should've made.

Share on Facebook
Share on Twitter
Please reload

Recent Articles:
Please reload

Search By Topic:
Please reload

Participating and Non-Participating Medical Providers

June 11, 2017

1/5
Please reload

© 2010 JL SMITH ASSOCIATES     >>>     Call us: 800-589-2240      >>>     4884 HIGBEE AVENUE NW., Canton, OH 44718 

This website is a private website and is not associated, endorsed or authorized by the Center for Medicare and Medicaid Services, nor do we claim to be. This site contains basic information about Medicare Supplement insurance for people with Medicare. If you would like to find more information about the Medigap program, please visit the Official US Government Site located at www.medicare.gov.