Sunday, April 3, 2011

if a person has medicare health insurance is it wise to use your spouses ins.as a secondary?

I was told that if your primary ins. covers 80% and you have a second ins. it will not cover anything over the 80% so what is the benefit of carrying 2 insurance coverages?
--------------------
Whoever told you that is definitely incorrect! Since I don't know the terms of your husband's policy, I'll use a hypothetical example here to try to show you how it works. Let's presume (for this example) that your policy through your husband has 80-20 coverage. (I'm also assuming, for simplicity's sake, that any deductibles have been met in my example. Just to give you a basic idea of how your secondary insurer might consider your claim.) Say Medicare approves $100 for one of your services. Since $100 has been approved, Medicare would actually pay $80. This would leave a balance of $20 after Medicare. Your secondary insurance would then consider the remaining balance of $20. Since your secondary also provides 80% coverage for that service, they would pay $16. Therefore the balance to you in this hypothetical example would be $4. (Medicare allowed charge - Medicare's actual payment - whatever your secondary pays = your balance.) There is no universal answer as to whether it is "wise" to use your spouse's insurance as secondary. It all depends on the terms of your spouse's policy and what premium you have to pay. For example, if your spouse has to pay a substantial premium to keep you on the secondary policy and it has a huge deductible, then it might not be worth it to stay on. If you never met the deductible, then the insurance would never make a payment. However, in general (and I stress "in general"), if your spouse's policy has decent coverage and you don't have to pay much of a premium to stay on it, then it might generally be worth it to stay on it. Another thing to consider - there are some things that Medicare just doesn't cover. For example, Medicare doesn't cover routine physical examinations. (other than the one-time physical they will cover during your first 6 months on Part B) However, if your spouse's policy provides coverage for something that Medicare doesn't, you can still use the secondary and not get stuck paying out of pocket. You'll have to evaluate whether you think its advantageous to you to stay on your spouse's policy. If you want to give more info on what kind of coverage your spouse's policy offers (deductible, what percentage it covers, how much extra premium your spouse has to pay to keep you on, etc.), it might be easier to help figure out what's best for you. Ooh...one more thing...prescriptions. If your spouse's coverage covers prescriptions, you might find that a better alternative than trying to figure out how to navigate Medicare Part D plans. (again, depending on how much you're paying in premium to keep yourself on your spouse's plan)
Source

No comments:

Post a Comment